Quality healthcare: A complete guide

When we think of healthcare, we often think of emergency doctors and hospital visits. 

But healthcare encompasses physical and mental care, preventative care, and emergency care. It includes everything from the care we need for our survival to elective procedures. 

Healthcare is a continuum of interactions that begins when a client first seeks care and concludes after their post-treatment follow-up.

But healthcare has issues. Researchers have raised issues regarding care disparities for decades, and associations have concerns about patient outcomes and safety. 

And in the wake of the pandemic, there's been considerable dialogue about what constitutes quality healthcare and whether we’re receiving it.

Let’s learn more about what quality in healthcare is, including examples and job roles. 

We can't compare quality in healthcare to quality dining, homebuying, or utility service calls. Healthcare's broad scope distinguishes it from other industries. 

We can really only compare healthcare to itself: One provider to another, one regional network to another, or one national healthcare infrastructure to another.

Still, we can define quality in healthcare and develop an accurate standard of measurement. 

The National Academy of Medicine defines quality in the healthcare context 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." 

In other words, we can determine quality by whether the healthcare service you receive helps you obtain the appropriate, desired outcomes based on current medical knowledge.

What ensures quality healthcare? 

Is it simply having a knowledgeable doctor? Quality care absolutely stems from a skilled healthcare practitioner committed to properly diagnosing, treating, and following up with patients. 

However, we need more than a skilled practitioner for quality care. Imagine these scenarios: 

• You come to a clinic experiencing acute and visible illness symptoms, but you spend several hours waiting for care.

• You've been prescribed a specific medication during an inpatient stay, but the nursing staff doesn't administer it promptly, or they give you a dose of the wrong medicine.

• A doctor misdiagnoses you because they accidentally use another patient's electronic health record, not yours.

Another key influence of healthcare quality is a practitioner's support staff and the equipment, systems, and policies their facility has in place. 

Healthcare also occurs in various settings, such as patient homes, government facilities, and online, which may affect service provision quality.

Finally, practitioners and patients may evaluate care quality differently. 

Patient perspectives are part of the picture that ensures an accurate, objective measurement of quality. Plus, a patient's bad treatment experience may exacerbate their underlying illness or injury under certain circumstances. 

Incorporating patient perspectives into a provider's overall quality measurement practices can ensure the provider understands their practice efficacy.

As multiple factors influence quality healthcare, measuring quality is a bit complex. 

Providers can use several models to measure healthcare quality and continually research the best measurement methods and metrics. 

Typically, you'll find the providers use quality assessment measures that address the following:

• Structure

• Process

• Outcomes

• Patient-reported outcomes

• Cost-efficiency

Providers select the measures most relevant to their practice and service area. In many cases, they rely on healthcare trade organization standards.

Healthcare practitioners and professionals often refer to "pillars of healthcare." These pillars refer to one of several frameworks that lay out standards for quality care. 

The Institute of Medicine's (IOM) six-pillar framework says quality healthcare should be:

• Safe

• Effective

• Patient-centered

• Timely

• Efficient

• Equitable

Incorporating these standards into their infrastructure and service helps providers elevate the quality of their healthcare.

While it can be difficult to measure healthcare quality, providers can implement concrete strategies to improve it. 

One framework for improvement is the Triple Aim, which the Institute for Healthcare Improvement (IHI) introduced in 2007. 

When a healthcare provider follows this framework, they seek to reduce the per capita cost of care while simultaneously improving population health and the care experience.

Improving population health

Within the Triple Aim framework, providers identify target populations in their service area and delve into community determinants of health. 

They examine their service offerings to adjust and expand as necessary to address the root causes of health disparities in those populations. 

Moreover, they seek to empower those communities with the tools to engage in preventative healthcare. This further mitigates the identified health disparities.

For example, the provider may identify that a population within their service area has a higher level of diabetes and undiagnosed prediabetes than the general population. 

The provider may add prediabetes testing to its standard on-site health screening and work with external partners to provide them in community settings where population members gather. 

Working with media outlets, elected officials, and prominent community members, the provider may also engage in public health education efforts about the dangers the condition poses.

Reducing costs

Healthcare costs are a significant determinant of healthcare access. 

According to the Kaiser Family Foundation: 

• A quarter of adults report rationing or not taking prescription medication due to cost. 

• 41% report having debt due to medical costs. 

• One-third either have or know someone who has skipped a medical test or procedure.

Providers must reduce costs for better health outcomes. Stress positively correlates with a higher risk of many different medical conditions and more difficult recovery from illnesses. 

Still, providers often find themselves having to do more with less. Whether from shrinking government reimbursements or insurance payments, coverage mandates, or labor costs, provider costs continue to rise. And shrinking provider budgets have a cascading effect. 

Healthcare outcomes suffer, employee morale worsens, and turnover grows. Labor costs rise to account for churn, and legal costs related to patient safety grow, further impacting budgets. 

Because of the outsized effect that costs can have on healthcare provision, the Triple Aim prioritizes their reduction to improve healthcare outcomes across the board.

Improving the care experience

Often, healthcare providers can find cost savings in restructuring their service provision. When they examine their services, they may find redundancies and deficits in areas like coordinated care, electronic health record (EHR) management, and billing. 

When providers focus on offering seamless care across their organization and others, they can: 

• Identify problems and solutions faster

• Ensure quicker recovery times

• Reduce costs for themselves and the patient

The Triple Aim encourages providers to improve the healthcare experience as it substantially affects patient health outcomes and safety, employee retention, and other crucial cost drivers. 

Beyond the financial impact, healthcare providers fundamentally exist to help people. And the continuous assessment and improvement of provider services is essential to ensuring patients receive the care they need.

The IHI website lists many case studies of quality improvement (QI) initiatives in healthcare involving the Triple Aim. 

However, there are other QI frameworks, such as: 

• Centers for Medicare & Medicaid Services' Meaningful Measures Framework 

• QIs developed by the Agency for Healthcare Research and Quality 

More broadly, the healthcare industry has leveraged new technologies and systems in QI initiatives in recent years. Some providers had been exploring telehealth to improve the quality of healthcare access to rural and other underserved communities pre-pandemic. 

Of course, telehealth's use exploded during the pandemic. And now, many providers are working on QI initiatives that improve telehealth quality regarding the breadth and depth of services and overall experience.

Providers also continuously seek to improve fundamental measures of healthcare quality, like: 

• Reducing patient length of stay and hospital readmissions

• Increasing the quality of coordinated care among departments and outside providers

• Reducing medication administration errors and related adverse events

• Streamlining EHR record management

• Cost containment and reduction

• Increasing patient safety outcomes

These are just a few of the outcomes those working on healthcare-related QI initiatives may seek. Providers may prioritize different outcomes depending on the services they offer, the needs of their service community, financial goals, and other organizational objectives.

Quality improvement is critical to the healthcare industry. 

Smaller providers may rely on generalist administrators and clinicians to spearhead QI initiatives. However, many providers rely on dedicated in-house QI staff to improve their services. 

Some providers lack the time or expertise to devote to QI, so they rely on outside healthcare QI consulting companies. QI work is not limited to private sector providers: Federal, state, and local government hospitals also depend on specialists to offer their patients the best care and services. 

Plus, healthcare providers aren’t the only ones who rely on QI experts. QI specialists can also be found in public health departments, lending their expertise to crafting policies that improve government-run, community-based, and private health systems.

Educational and professional requirements vary by position and employer. However, many employees in healthcare quality improvement possess a graduate degree in healthcare administration, nursing, public health, or a related field. Some also have clinical experience.

If you're considering a field in healthcare QI, consider whether you'd like to work in the private or public sector. Decide whether you’re more drawn to in-house or consulting positions, and tailor your training and education plans accordingly.

When you're conducting your job search, you may come across job titles, such as:

• Healthcare Quality Improvement Coordinator or Specialist or Analyst

• Clinical Quality Improvement Coordinator or Specialist or Analyst

• Pharmacy Quality Improvement Coordinator or Specialist or Analyst

• Clinical Documentation Improvement Specialist

• Continuous Quality Improvement Specialist

• Quality Improvement Trainer

• Healthcare Quality Improvement Manager or Director

• Clinical Quality Improvement Manager or Director

• Healthcare Quality Improvement Consultant

Some titles will include the area where you'd apply your QI expertise, such as Quality Improvement Coordinator, Medicaid. 

Many employers want in-house QI workers with direct experience in a specific field. Depending on the positions you seek, it may make sense to take a non-QI position to help you gain firsthand knowledge in the areas you'll work to improve in your QI role.

Quality improvement (QI) is essential to ensure high levels of patient safety and better patient health outcomes.

Moreover, QI initiatives often help healthcare providers and systems save costs and improve efficiency.

Many QI initiatives improve care, reduce costs, and increase population health. 

For example, a healthcare provider may test, deploy, and measure the results of a new electronic medication management system that reduces medication dispensing errors.

Healthcare providers and QI specialists seek to develop QI initiatives that are: 

• Safe

• Effective

• Patient-centered

• Timely

• Efficient

• Equitable

These six pillars are drawn from a 2000 IOM report that noted that nearly 100,000 Americans die annually due to medical errors.

All QI initiatives consist of these four components: A problem, a goal, an aim, and measures. 

QI specialists start with the identified problem and determine the appropriate goal to address it. They break the goal into manageable pieces called aims. They also determine the appropriate measures to evaluate performance.