Nursing Code

The Modern Quality Movement

In this post we will explore some aspects of the modern quality movement in healthcare.

As consumers have grown in knowledge, trust in the medical profession has decreased. No longer do doctors and nurses 'know best', consumers are well informed and expect the highest quality of care.

What is high quality care?

Quality can be defined as the

Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge 1

A much broader concept of quality is suggested by Avis Donabedian in that

quality incorporates other areas, such as amenities, efficiency, access and financial considerations as well as the competence and training of practitioners 2

When considering quality in the context of Accreditation and the National Standards, the broader view is the more applicable one and ensures that we consider more than simply evidence based care.

And if you think about it, quality really is broader than successful, but utilitarian treatment. Quality is the difference between being grateful for something and begrudging acceptance.

It may seem trite to compare the manufacture of consumer devices with life saving care, but consider this short video from Apple

What would care look like if we look through the eyes of an Apple designer? Would we be able to adapt our processes until everything we touch enhances each life it touches ?

Clearly there are many constraints that mean we cannot simply just 'design' the care we give, but we can take enormous steps to design the journey of care to better match the lives of our patients. Looking through their eyes rather than our own.

Empathy is often the key element that defines the difference between care that it perceived as high quality vs care perceived as low quality. It's the time taken to explain why we're putting on anti-embolic stockings, the time we take to guide you to the ward when you're lost and confused by the hospital layout and it's not tutting when the 20th person today comes to the wrong department because they don't know the difference between cardiology and cardiothoracic clinics.

Partnering with consumers AKA National Standard 2

A great step in the right direction for meeting action 2.1.2 (Consumers and/or carers are actively involved in decision making about safety and quality) is to begin actively asking patients about their experiences of interacting with your facility.

A great example of this is looking at the scheduling of services such as pre-anaesthetic clinics. Many patients find it difficult fitting appointments around their work commitments. Imagine how much higher patients would rate the quality of your service if it fit around them, rather than us! Late appointments once or twice a week could make all the difference to your non-attendance rate.

Thanks for taking the time to read this post and I look forward to sharing more tips with you in the weeks to come.

1 Kohn K, Corrigan J, Donaldson M. To err is human: Building a safer health system Washington DC: National Academy Press; 1999.

2 Donabedian A. The quality of care: How can it be assessed? JAMA. 1988; 260: p. 1743-8