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Highlights
•
“Quality care” definitions must encompass the perspectives of physicians, nurses and patients.
•“Quality care” judgments are mainly based on care processes, less on structures or outcomes.
•Successful communication and staff motivation are core indicators of high-quality care.
•“Hippocratic pride” in response to care successes constitutes a new quality care indicator.
•“Rapid reactivity” in response to (near) failures constitutes a new quality care indicator.
Abstract
Objective
Existing quality of care frameworks insufficiently integrate the perspectives of physicians, nurses and patients. We collected narrative accounts from these three groups to explore if their perspectives might add new content to these existing definitions.
Methods
Ninety-seven descriptions of “good” and “poor” care episodes were collected from a convenience sample of physicians, nurses and outpatients at eight regional hospitals. Two coders classified the narrative contents into themes related to structures, processes and outcomes of care.
Results
The physicians, nurses and patients raised the following “quality of care” aspects: Successful communication among staff, with patients and care companions; staff motivation; frequency of knowledge errors; prioritization of patient-preferred outcomes; institutional emphasis on building “quality cultures”; and organizational implementation of fluid system procedures.
Conclusion
Respondents primarily referred to care processes in their descriptions of “quality of care.” “Hippocratic pride” (in response to care successes) and “Rapid reactivity” (in response to (near) failures) emerged as two new outcome indicators of high-quality care.
Practice implications
This study provides a first qualitative fundament for understanding the components of “quality of care” from a triangulated frontline perspective. Future research needs to validate our findings with quantitative data to explore their usefulness for completing existing quality frameworks.
Keywords
Healthcare quality
Quality culture
Quality assessment
Quality improvement
Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
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© 2021 The Author(s). Published by Elsevier B.V.
Stanford Health Care is committed to providing clear, accurate and honest information about the quality of care we offer to all of our patients. The quality data included here is the next step in an ongoing effort to increase the level of transparency around quality data so that our patients can make informed health care decisions.
What is quality?
Patients and families know quality care when they experience it. A nurse's response time, a doctor's bedside manner, the hospital's atmosphere—all of these things affect how people feel about the quality of their healthcare.
When hospitals talk about quality, it is generally in reference to very specific clinical data collected and analyzed over a period of time. Quality measurement isn't always easy. Different agencies and groups have different ways of reporting clinical outcomes that can affect the way they rate a hospital on a certain quality measure. Reporting systems can also be cumbersome or costly, making ratings even more difficult to produce. Today, there are limits to the numbers of conditions, treatments, and procedures that are reported and monitored, but as data systems and methods improve, more and more information will be available.
Quality data show how well a department or institution achieves desired health outcomes for a particular procedure, often by tracking how closely clinical staff meet standards of care. At Stanford Health Care, we strive to ensure that the care we provide is:
Safe: Avoiding injuries to patients from the care that is intended to help them.
Effective: Providing services based on scientific knowledge and best practice.
Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs and values, ensuring that patients' values guide all clinical decisions.
Timely: Reducing waits and sometimes harmful delays for both those who receive and provide care.
Efficient: Avoiding waste, including waste of equipment, supplies, ideas and energy.
Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socio-economic status.
Measuring quality data allows us to see where we are providing the best care and helps us identify areas for improvement.