By: Imogene Foster, EdD, RN, LPC, Associate Professor and Coordinator of Rural Health Nursing Education, West Virginia University School of Nursing
Quality of care is a goal that health care professionals strive to achieve on a daily basis. Exploring the meaning of quality and individual and team commitment to quality are important lessons to incorporate in the education of health professions students. Webster’s dictionary provides a simplistic definition of quality, “grade, degree of excellence; superiority of kind”. Exploration of early experiences related to quality will help students to appreciate the meaning of quality in their daily lives.
Students who had the opportunity to participate in an organization such as a 4 H Club (the 4 H’s being “head, heart, hands, and health”) learned how to grade their own workmanship and to have their work evaluated through exhibits at county and state fairs.
A guide for grading (the quality of) a garment would include criteria such as: “Is the garment cut correctly?; Does the color and size of the thread match the material? Does the machine stitching show good tension?” Judges would subsequently evaluate the workmanship according to criteria and award a ribbon to symbolize the quality of the work.
Lessons from youth provide the foundation for learning the connection between quality and performance. One learns that outcomes are connected to knowledge, skill and effort. Individual workmanship and pride in achievement pave the way for team
workmanship and pride in group accomplishments. Judges of quality in the health care arena include the total community—peers, consumers, administrators, and legal and governmental representatives. Developing and valuing partnerships become imperatives in achieving quality care when attention is focused on individuals and populations as recipients of health care.
Webster’s definition of quality is helpful but not sufficient for understanding the meaning of quality in health care. Excellence in care is still the overarching goal. However, a definition of quality that reflects the nature of the product(s) in health care is needed. Members of the Institute of Medicine (IOM) have been concerned with quality of health care for decades. They offer the following definition:
Quality
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 the decade of the 1990’s, the
Institute of Medicine (IOM)* launched a quality initiative to address the
“widespread and persistent, systemic shortcomings in quality” in the health
care system in America. The first phase
documented the “serious and pervasive nature” of the nation’s overall quality
problem. The second phase emphasized
how the health care system and related policy environment must be transformed
to “close the chasm between what we know to be good quality care and what
actually exists in practice” (http://www.iom.edu/focuson.asp?id=8089)
. The series of reports related to this
initiative put a national spotlight on issues related to patient safety and
quality. To Err is Human described how tens of thousands of Americans die
each year from medical errors. The
follow-up report, Crossing the Quality
Chasm: A New Health Care System for the
21st Century, recommended
the need to address the way health
professionals were educated and paved
the way for developing a blueprint for reform in health professions education.
Health Professions Education: A Bridge to Quality, the blueprint for reform, was developed by an interdisciplinary team of experts at a Health Professions Summit in 2003. In this report, the committee recommends the following overarching vision for all programs and institutions engaged in the education of health professionals:
All health care professionals should be
educated to deliver patient-centered care as members of an interdisciplinary
team, emphasizing evidence-based practice, quality improvement approaches, and
informatics.
The committee proposed the following set of core competencies “ that all health clinicians should possess, regardless of their discipline, to meet the needs of the 21st century health care system” (IOM Report, 2003, pp.45-46):
Interdisciplinary case-based, problem-solving can contribute to the development of these core competencies, and thus move students in the direction of collaboratively building the bridge to quality care. At the end of each interdisciplinary session, participants can evaluate the extent to which quality of care was promoted through attention to a review of each core competency. In addition, the team of students can determine the extent to which the competencies helped to advance any one of ten rules of performance (IOM Brief Report, 2001) and/or any of the six aims (Ibid, 2001) leading to improved quality in the health care system.
It is important to note there are two basic approaches to quality improvement: general and specific (Stanhope & Lancaster, 2004). Promoting quality with emphasis on developing core competencies for health care professionals is part of a general approach to improve quality through curricular revisions in educational institutions and programs. Addressing quality management and continuous quality improvement are examples of specific approaches. Health professions students should understand the basics of each of these approaches. In addition, they should be encouraged to share information across disciplines to gain an appreciation of the contributions of each member of the health care team. An example for group discussion is types of degrees in nursing and licensure for professional nurses.
There are many challenges in providing quality health care to individuals, families, and populations. The development of partnerships among health care professionals, with attention to core competencies, is a significant step toward increasing the likelihood of desired health outcomes for individuals and populations who are recipients of care.
*The
nation turns to the Institute of Medicine (IOM) of the National Academies for
science-based advice on matters of biomedical science, medicine, and
health. A nonprofit organization specifically created for this purpose as well
as an honorific membership organization, the IOM was chartered in 1970 as a component
of the National Academy of Sciences. The Institute provides a vital service by
working outside the framework of government to ensure scientifically informed
analysis and independent guidance. The IOM's mission is to serve as adviser to
the nation to improve health. The Institute provides unbiased, evidence-based,
and authoritative information and advice concerning health and science policy
to policy-makers, professionals, leaders in every sector of society, and the
public at large (http://www.iom.edu/about.asp ).
References:
IOM Brief Report, March, 2001, Crossing the Quality Chasm: A New Health System for the 21st Century. The National Academies Press: Washington, D. C., pp. 1-3.
IOM Report, 2003, Health Professions Education: A Bridge to Quality. The National Academies Press: Washington, D. C.
Stanhope, M. & Lancaster, J. (2004). Community and public health nursing. Mosby: St. Louis, pp. 521-523.