External and Internal Drivers of quality assignment

External and Internal Drivers of quality assignment

This week you will focus on your reading assignment and at least 3 other sources to create a summary of internal/external drivers on quality that may impact your chosen topic quality outcomes.

Compare and contrast external and internal drivers on quality and explain how they will benefit your chosen topic by reviewing positive and negative impact. You will discuss the impact of internal and external drivers for hospitals and providers.

Healthcare service quality is associated with patient satisfaction (1), loyalty (2) and healthcare organizations’ productivity and profitability (3). As a result, healthcare organizations throughout the world consider it as a strategic differentiator for sustaining competitive advantage. Therefore, it is very important to define measure and improve quality of healthcare services.

Quality healthcare is a subjective, complex and multi-dimensional concept. Mosadeghrad (2013) defined quality healthcare as “consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical

guidelines and standards, which meet the patient’s needs and satisfies providers”. He believes that quality healthcare is “providing the right healthcare services in a right way in the right place at the right time by the right provider to the right individual for the right price to get the right results” (4). He identified 182 attributes of quality healthcare asking 700 healthcare stakeholders including policy makers, managers, providers and patients using pluralistic evaluation and grouped them into five categories: environment, empathy, efficiency, effectiveness and efficacy. Quality healthcare includes characteristics such as availability, accessibility, affordability, acceptability, appropriateness, competency, timeliness, privacy, confidentiality, attentiveness, caring, responsiveness, accountability, accuracy, reliability, compre-hensive-ness, continuity, equity, amenities and facilities. Ensuring safety and security, reducing mortality and morbidity, improving quality of life and patient involvement have also been seen as quality attributes (5).

Donabedian defined medical services quality as ‘the application of medical science and technology in a manner that maximizes its benefit to health without correspondingly increasing the risk’ (6). Øvretveit defines quality care as the ‘Provision of care that exceeds patient expectations and achieves the highest possible clinical outcomes with the resources available’ (7). For Lohr, quality is “the degree to which healthcare services for individuals and population increases the likelihood of desired healthcare outcomes and is consistent with the current professional knowledge” (8).

However, distinct healthcare industry characteristics such as complexity, intangibility, heterogeneity and simultaneity make it difficult to measure and improve quality in this sector (9). Healthcare systems are among the most complex systems serving humans. Delivery of quality healthcare services requires coordination among a number of different organizations and providers. It also needs coordination of highly complex diagnostic, therapeutic and logistic processes and practices. The very complexity of the healthcare system and its bureaucratic and highly departmentalized structure pose a significant obstacle to quality improvement in healthcare. Furthermore, healthcare problems are complex and require a high degree of customized solutions (10). Every situation and every patient is different. A simple task requires the communication and co-operation of various departments and employees.

It is difficult to establish a link between the inputs and the quality of clinical outcomes in the health sector owing to the intangibility of healthcare services. Many variables such as patients’ socio-demographic factors (e.g., age and gender) and severity of illness affect the outcomes in healthcare. The outcomes are also dependent on the compliance and co-operation of patients themselves. Different professionals (e.g., physicians, nurses, etc.) deliver the service to patients with varying needs. Healthcare professionals provide services differently because factors vary, such as experience, individual abilities and personalities. They have their own definition of quality and follow specific ways to achieve it (9)