Quality is hard to define in healthcare because healthcare delivery is so complicated. Consequently, evaluating healthcare quality isn’t simple either. This is why there are multiple quality measurement frameworks that look at many different factors to understand whether doctors and facilities provide good care. The National Committee for Quality Assurance (NCQA) includes over 200 measures in its HEDIS quality framework which are measures of physician outpatient and office work. CMS shares almost 100 measures on hospital timeliness, mortality, complications, and patient satisfaction on Care Compare.
It was often easier to define quality healthcare in terms of patient safety and errors in healthcare. It was easier for people to relate to quality in terms of their or their relative’s experiences with medication errors and things that went wrong in hospitalizations.
In 2001, the Institute of Medicine’s report Crossing the Quality Chasm proposed six dimensions of healthcare that now healthcare systems have come to believe are the components of quality care: safe, effective, patient-centered, timely, efficient, and equitable. Quality of care is the degree to which healthcare increases the likelihood of desired health outcomes and is based on evidence-based professional knowledge and practices.
The Committee on the Quality of Health Care in America proposed six aims for healthcare, envisioning that it should be:
- Safe – avoiding injuries to patients from the care that is intended to help them
- Effective – providing services based on scientific knowledge to all who could benefit and avoiding underuse, and overuse
- Patient-centered – providing care that is respectful of and responsive to individual patient preferences, needs, values and ensuring that patient values guide all decisions
- Timely – reducing waits and sometimes harmful delays for both those who receive and those who give 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
With this definition of quality, patients would experience care that is safer, more reliable, more responsive, more integrated and more available.