Services provided by a hospital incorporate elements which can be examined objectively, subjectively or both. Every enterprise is actively concerned with quality assurance by determining the quality of the commodity it produces and keeping in touch with consumers to secure their maximum satisfaction. As a result of advances in medical technology, introduction of complex diagnostic and therapeutic procedures, introduction of high technology and other sophisticated elements. Evaluation is designed to measure the efficiency and effectiveness of the services after planning, organising, directing and controlling.
No organisation worth its name can survive and progress unless it overcomes its shortcomings and builds upon its past performance. Sophisticated technology in high-tech hospitals is equated with high quality care in the minds of both public and the providers, and high costs and quality are considered synonymous.
The quality assurance committee has to ensure that there has to be a basic minimum infrastructure regarding space, equipment, physical facilities and the staff requirement. The type of organisation needed for each department or service that is the authority-responsibility relationship, coordination and the budget has to be tailored to the need of each department keeping in view the overall hospital objectives.
To most people the word “audit” is familiar in relation to financial transactions justifying use of financial resources and thereby establishing guides for further financial operations. Hospital services are no expectation to such audit, except that this audit directly relates to patients. Viewed as a means of justifying the use of medical care resources and thereby establishing a guide for future medical care operations, it has come to be known as the medical audit. The audit is based on the study of medical records in retrospect wherein questions regarding what was done for the patient, wrongful commissions and omissions, under or over treatment, justifiability and outcome are raised.
Springing from medical audit, comprehensive quality assurance system was a logical next step in the evaluation of the technical content of medical care that can encompass as many clinical disciplines in the hospital as possible and also the supportive services. Since the major output of hospitals is patient care, maintaining quality is a primary objective, and quality assurance becomes a critical control activity. Essentially a retrospective auditing process, quality assurance incorporates credentialing and the performance to evaluate the physician’s, and indirectly of the clinical supportive services performance. In death review, scrutiny of all fatal case documents can be used to adjudge the professional competence of the medical staff and provide useful feedback for policy planning.
Evaluation in hospitals is complicated by the multidisciplinary nature of activities, diversity of staff, variation in the intensity of care of each patient and the intangible outcomes of medical care, thereby forcing qualitative judgements on the evaluations. What one measures is therefore only certain components and characteristics from which inferences are drawn and corrective actions are taken.
External quality assurance is seen as being concerned with the setting of explicit standards of service over wide areas of health care system by independent outside authority, which can then be checked by independent assessors of the kind practised. Internal quality assurance is seen as essentially a local exercise, whereby the activities of physicians and surgeons are subjected to a confidential review by their peers designed to improve patient care and encourage professional self-evaluation.
The quality assurance process has been divided broadly into two components: (i) the one relating to the ‘care’ services encompassing the organisation and the men-materials, money- machines inputs and their utilisation which had been dealt with under general evaluation of hospital, and (ii) the other relating to the ‘cure’ services incorporating professional and technical study of patients’ medical records culminating in medical audit. The former has been profitably carried out by hospital administrators, whereas the latter is considered as an exclusive domain of the medical staff themselves.
If both the provider and the recipient of medical care service are equally convinced that the service is not only of good and acceptable standard but can be shown to be so, then both will be equally satisfied.
Upasana Baral
Associate consultant
Quality & Management, Integra Ventures