Quality of healthcare

The general mission of JCTLM was agreed to be improvement in quality of healthcare with reduction in costs for governments and IVD industry through promotion of reference examination systems allowing traceability of examination results with improved comparability. 

Committee on Quality of Healthcare in America. To err is human Building a safer health system. In Kohn LT, Corrigan JM, Donaldson MS, editors. Washington, DC National Academy Press 1999. p. 223. 

This definition goes some way to differentiate patient safety from more general concerns about the quality of healthcare the focus is on the dark side of quality (Vincent, 1997), care that is actually harmful rather than just not of a good standard. Healthcare is, in many cases at least, inherently hazardous and the definition implicitly acknowledges this. The definition also refers to the amelioration of adverse outcomes or injuries, which broadens the definition beyond traditional safety concerns towards an area that would, in many industries, be called disaster management. In healthcare, amelioration firstly refers to the need for rapid medical intervention to deal with the immediate crisis, but also to the need to care for injured patients and to support the staff involved. 

Robinson, A.R., Hohmann, K.B., Rlfkin, J.I. etal. (2002) Physician and public opinions on quality of healthcare and the problem of medical errors. Archives of Internal Medicine, 162(19), 2186-2190. 

Guy Cohen was Direaor of Quality, Safety and Reliability at NASA until the mid-1990s. Don Berwick, then working on improving the quality of healthcare in the Harvard Community system, had asked how to improve healthcare faster and more effectively in their first five-hour meeting Cohen had barely started telling him what he had learned about quality and safety (Berwick, 1998). Berwick recalls the response to his initial question ... 

A positive safety culture seems like a good idea. Surely to have a safety aware workforce, imbued with safety attitudes, open about error and so forth must be helpful But is there any evidence that changing the culture is likely to improve the quality of healthcare or the safety of patients A few years ago the answer to this was simply no, or at best only indirect evidence. Now however, a cadre of brave researchers undaunted by conceptual and methodological minefields have begun to address this issue. But it is difficult and there are no simple answers. 

From the viewpoint of health care by pharmacies some additional quality characteristics may be taken into account availability, continuity of care, timeliness. Those characteristics are mentioned by ISO 9001/EN 15224 (see Sect. 35.7.2) and identified as inherent characteristics for the quality of healthcare services. They may however conflict with the usual characteristics for product quality. Conflicts are easy to be imagined between for instance ... 

Kilpelainen et al. s paper [68] describes the first comprehensive assessment of the availability of general health data in Europe. Use of the European Community Health Indicators (ECHI) is not equally distributed across the 31 member states. The availability score ranges from 56% to 84%. Furthermore, many important ECHI indicators are not available in most European countries. Missing data usually pertained to health determinants, the provision and use of healthcare services, the quality of healthcare, injuries, and health promotion. The European Union would benefit from the development of a European health information system for public health monitoring. 

Electronic health record (EUR) is a computerized patient-centric history of an individual s health care that includes treatment records from multiple providers, clinical information, and administrative tasks for patient management. It is built from data in electronic medical record (EMR), which is specific to a provider. EHR enables linking of clinical information with payment systems, and can retrieve data from multiple sources of care that the patient might have used. Because they are interoperable, they can be accessed at any point of care. It makes it possible for patients to obtain accurate and reliable information about the cost and quality of healthcare. Note that interoperability and data transparency require national data standards. 

This book would not have been possible without the generous funding 1 received from the Economic and Social Research Council, award numbers S42200134055 and PTA-026-27-0984, a collaborative industry partner in the airline industry who shall remain nameless (though anonymity does not belie gratitude), and an Improvement Science Fellowship from the Health Foundation, an independent charity working to continuously improve the quality of healthcare in the UK. I am grateful for all of this support. 

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