Signature Assignment: Outcomes and Quality

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delivery of medical care was increasing in complexity and the process of delivering care was about to move into the computer age. This is important because today caregivers are working in a significantly more complex environment with an associated increased risk of error and system failure—and the consequences of error are more severe (Guarinoni, Petrucci, Lancia, & Motta, 2015).

The amenities of care speak to the patient’s interest in being treated in comfortable, clean surroundings while the ethical principles speak to the provider’s ethical conduct in delivering care and his/her interest in furthering societal and organizational well-being (or effectiveness). A related, but more focused, view of quality represents two fundamental questions about any clinical service, procedure, or activity occurring in a health care setting: (1) “are the right things done?” and (2) “are things done right?” The first question assesses the effectiveness of clinical care; the second considers the efficiency of care services. Importantly, the performance of health care organizations depends on both its effectiveness and efficiency.

In 2001, Crossing the Quality Chasm (IOM, 2001), proposed that health care should be: “safe, effective, patient-centered, timely, efficient, and equitable” (pp. 5– 6). These six dimensions of care are addressed through a variety of methodologies and metrics—many of which

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are measured in the eyes of the beholder, i.e., the patient and the system simultaneously. In the past, the patient perspective was not part of the equation. Since the IOM report, best practices are to include the patient and the populations served as part of the health care team. Per the IOM (2001) report, effectiveness is defined as “providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse)”; and efficiency is defined as “avoiding waste, in particular waste of equipment, supplies, ideas, and energy” (p. 6). These concepts will be expanded upon in the next section.