Health Care Quality and Safety Improvement Strategies

Different health care quality and safety improvement strategies are used in different health systems, such are:

Resources Increase: strategy represents increase of financial means, staff, facilities and equipment used in health system aiming to treat larger number of patients or the same number of patients in a faster, better and cost reduced way.

System Reorganisation and Large-scale Financial Reform: strategy implies change of health system structure in a way to ease making of decisions based on relevant information or better use of resources. Changes in methods of financing as a quality improvement method are very often in the world.

Management Strengthening: strategy represents quality improvement based on increased management responsibility and competencies. This is sometimes used as a part of other strategies.

Development and Implementation of Quality Standards and Guidelines to Clinical Practice: strategy implies defining of standards related to expectations from health service providers, communication with beneficiaries and other health service providers, then organising training on standards and guidelines and their implementation. Standards can be developed for national or local level as well as guidelines to clinical practice for different medical conditions. Most of medical and clinical audits belong to this category which is a case with some other approaches named “quality insurance” and development and implementation of clinical pathways.

Promotion of Patients Rights and Patient Empowerment: strategy implies empowerment of patients through for example complaint system or patient satisfaction survey, as well as giving publicity to information about what patients should expect. There could be some methods of growing power of patients through legal rights, advocacy or other institutions such as a right to be treated within 30 minutes of arrival to ER and so on. The other example is adoption of the Charter on the patients’ rights which clearly define patients’ rights, entity of ombudsman and other patient empowerment systems.

Quality Management System: defines responsibilities related to quality and establishes structures and systems which provide them. The International Organization for Standardization (ISO) gives guidelines used by some countries to design quality management systems. Content of those guidelines is interpreted differently depending on a country so consequently there are different quality management systems.

Quality Evaluation and Accreditation, Internal and External: There are numerous evaluation systems; the most known in Europe is the European Foundation for Quality Management) which is based on the American Baldridge Award system.  Similar strategy is a voluntary or mandatory external quality evaluation done by third-party peer review organization, or some other relevant state body. This could imply awarding formal accreditation status. Accreditation systems vary according to the surveyed aspects and whether audits include quality incomes. Most of the time it is used as a quality evaluation system in well developed health systems

Total Quality Management (TQM) and Continuous Quality Improvement (CQI): TQM is set of practices and methods applied in different ways that come from organisationally different industrial quality programs. This strategy is focused on attentiveness of staff and providing the best possible experience and outcomes for patients. Multidisciplinary teams use quality instruments in order to lead to changes. The approach requires strong leading role of management. It is based on the opinion that problems on quality are often related to weak organisation rather then individual mistakes. In most of the literature, CQI is the same as TQM, even it sometimes refers to a focus on multidisciplinary project teams where is analysing work processes and use repeated cycles of testing small changes.

Quality Collaborative: national and regional strategy in Australia, Norway, Sweden and USA, promoted by UK NHS, and best tested in developing countries with mid-range average income. The strategy should gather project teams from number of different health institutions. Teams should, in nine months time, meet every three months in order to learn and apply quality methods and give a report on their progress. The strategy is developed in a way to provide the economical way of learning an effective practise model and a quality model in order to get results that are faster than results achieved by CQI/TQM strategies.

Re-engineering: uses some of the methods of TQM but includes some more radical re-designing of „production process“ than TQM approach that implies small-scale changes.

Quality Indicators Comparison: strategy is trying to motivate patients, clinicians and others to use quality information to achieve improvement but it is not strictly set. It can be used by a health care institution participating in a program of collecting comparison data or as a voluntary or required strategy for institutions in some areas to collect and inform data. Some comparison systems are public and promoting encouragement of patients and service providers to take actions on quality improvement.  

Benchmarking: uses comparison quality information with additional methods to help service providers to decide on a way used to improve quality. The process implies existence of specific methods for identification, documenting and applying the best practices.

Risk Management and Safety: strategy identifies high risk procedures and situations that put a hospital in a financial risk or other risks due to patients’ claims. It includes methods of identifying causes of adverse events. Patient safety strategies often include risk management and other methods from other industries for collecting and analysis of adverse events or near miss reports with review on prevention.

Peer Review (Dutch visitatie): peer, often mono-disciplinary programs for evaluation and formal accreditation of training programs but also often used for peer survey of health care providers.

Registration and Licensing: legally required programs ensuring that professional staff and service providing organisation achieve minimal competency standards (e.g. training, registration, certification, and re-validation); in numerous countries there are specific inspections for public health and safety (e.g. fire, radiation and infection).