Quality Health Care

How Can We Define “Quality” in Health Care?
Donald Berwick, MD, MPP, Former President and CEO, Institute for Healthcare Improvement
Learning Objectives: At the end of this activity, you will be able to:
• List the six dimensions of health care quality listed in a 2001 Institute of Medicine report Crossing the Quality Chasm.
Description: In this video, IHI’s Former CEO Don Berwick describes a 2001 report by the Institute of Medicine, Crossing the Quality Chasm, that laid the foundation for health care reform in the United States and spread around the world.

Unable to view this video? Read the transcript.

Discussion Questions:

1. Don Berwick describes six dimensions of quality in health care: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Have you ever encountered a failure in any of these areas as a patient or as a clinician? Describe the experience and how you would have liked it to be different.
2. In your hospital, clinic, or town, which of the six dimensions of quality presents the greatest challenge? In which area, if any, does your hospital, clinic, or town excel? What experiences have you had to support your views?

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• by Karthik Iyer 4/4/2017 5:21:10 AM 1. Failure of patient-centeredness and efficiency primarily. There is a lack of involving the patients in the decision-making process or explaining consents for surgical procedures adequately. Busy OPDs to ward rounds mismanaged by poor scheduling ends up hurting patients as they don’t get enough face time with the doctors. Also, the workforce seems lethargic and due lack of incentives or a structure of accountability, the efficiency of getting things done is lacking. In an OT setting this is seen in lack of implementation of the surgical safety checklist and proper disposal of biomedical waste in the correct bins. 2. Patient-centeredness poses the greatest challenge. Education, research, getting large number of surgeries done often takes more priority over patient care and human aspect of medical care. Given the ingrained behavior of not giving primary importance to the patient, this poses the greatest challenge. 2.
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• by Solomon Negash 2/19/2017 1:12:23 AM safety, effectiveness, patient centerless, avoid delays, efficiency, and equity are the 6 dimension of health where we can measure the quality.
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• by Jesse Struckhoff 7/11/2016 1:10:25 PM great session
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• by Dinah Amongin 3/3/2016 3:25:11 PM Failure in all the 6 dimensions is literally the norm in my country. I have encountered this both as a patient and a clinician. I will give one example, the issue of timeliness. As a clinician, I have had major challenges in this area and one of the most traumatizing issues is the waiting time for a woman to access an emergency cesarean section. Many of the patients have to wait on average for 8 hours to access the procure which should be done within 30 minutes of the decision. I would have wanted this to change to the recommended standard by WHO.
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• by Okwuchi Ogbonnaya 11/5/2015 3:29:33 AM In my work place the quality in health care that presents greatest challenge is equity. There is discrimination on the part of the managers on the individual that makes report of safety laps. The managers listen only when whomever they like present an issue, they do nothing or blame the messenger if the person who reported any safety laps is not one of their favorites. This makes it difficult to continuously improve on the quality of care.
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• by Deanna Prater 10/8/2015 4:53:28 PM Safety is the biggest challenge. Similar to what we are seeing at a national level, violence in the Healthcare setting is at least 4x that of any other industry in the nation. Unfortunately, the rights of the patients and family members trump the rights of the healthcare workers. Patients and family members have no code of conduct even they are voluntarily coming to hospitals for care. We are inundated with threats, violence and harassment. One example, I had a patient that came into the hospital positive with Methamphetamines in his system. He wanted to go out to his car. Under our current policy, I cannot detain him. He has the right to go out to his car, use more meth, and subsequently return to his room completely irrational and violent. Unfortunately, his right to use meth and engage in violent, abrasive behavior trumps my right to provide care in a safe and respectful setting. This is going to change.
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• by Deanna Prater 10/8/2015 4:48:49 PM I see a need for improvement with efficiency. I live in a geriatric community. I find that we are often duplicating labs and testing that is being done for, more or less, a curiosity. For example, if I have a 95 year-old gentleman dying of cancer, doing another CT to show where it has spread is a waste of resources and it is trying for the patient though withstand the procedure just for the sake of “knowing.” We often receive patients transferred from other facilities. There is often a delay in getting copies of labs and tests they’re had done at the previous facility, and so they are re-done where I work. This, again, is a waste of resources.
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• by Blake Moore 9/21/2015 10:27:40 AM https://www.bostonglobe.com/metro/2014/07/25/two-candidates-for-governor-report-million-dollar-jobs-health-care/SbFKEQorrCyzN94sVy72VM/story.html Income for Dr. Berwick increased dramatically following his government appointment and the rise of AHA. Appears to be related to “speaking fees” talking about healthcare, and I think this should be disclosed.
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• by Jennifer Morrison-Diallo 9/15/2015 11:38:34 AM In the hospital I work in, the dimension which presents the greatest challenge is safety. Working in behavioral health, safety is a VERY important concern. One major problem with safety is that we have very acute patients with problem behaviors on the inpatient psychiatric units which at times hurt themselves or other staff or patients. One major breakdown with safety at times, is the lack of communication among staff about what triggers the patient and what they should look out for to avoid another incident. If staff would effectively communicate observed triggers, this could avoid potential conflicts among patients and staff.
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• by penny ebert 10/20/2014 1:39:05 PM I believe that our hospital view the 6 dimensions are present. We have had a great push for safety in last few years-esp. regarding falls. Effective care has been stressed with looking at nationwide nurse centered indicators and making our goals align with these being the best outcomes for our patients. patient centered care has been a big push in our policy and our approach-during all conversations when it comes to standards-it always wraps back to the patient centered approach. Timeliness we lag in-many efforts are in place to improve here-we have lots of room for improvement. I feel that with our wastefulness still is tremendous-there is a push of course with the program known as LEAN- I think that we will continue to find areas of high waste-hopefully the intense examination of our practices will eliminate our excesses. Our equality I believe is being handled very well- I don’t see any difference in the care of individuals based on any demographic factors