Quality Healthcare Delivery Guidebook

Purpose and objectives

The purpose of this document is to serve as a guidebook for healthcare practitioners to improve the quality of care and delivery within their organisations. This document will cover the background principles of quality healthcare delivery, steps and guidelines for effective healthcare delivery, useful measurements and evaluation tools, implementation processes, and a case study of quality healthcare delivery.

A practical and technical resource for quality improvement initiatives in healthcare delivery is important to continue to ensure a consistent and rigorous standard of healthcare for patients globally, in order to ensure healthy lives and promote well-being for all ages, as outlined in the U.N. sustainable development goals. (World Health Organization, 2018)

Background information

As the complexity and number of healthcare conditions increases globally, and as the global population continues to rise, healthcare practitioners and organisations are increasingly under strain to continue providing quality healthcare to their patients and constituents. It is important that healthcare practitioners such as doctors and nurses have access to a practical guide to improve the quality of care and delivery within their organisations, in terms of guidance, implementation, manuals, guidelines, frameworks, capacity building and assessment. (World Health Organization, 2018)

Improvements in quality healthcare delivery apply to a variety of areas, which include infection prevention and control, emergency room care, community engagement, patient safety, hospital management, palliative care, blood safety and primary care. Although these different areas of healthcare and medical practice have unique needs, common practices to improve the quality of care and delivery of organisations in delivering services in these areas can be used. (World Health Organization, 2018)

Principles of Quality Healthcare

Generally, quality healthcare delivery is governed by the following seven principles of effectiveness, safety, people-centricity, timeliness, equity, integratedness and efficiency. (World Health Organization, 2018)

Foremost, quality healthcare delivery should be effective, in providing evidence-based care to the patients who require them most. Quality healthcare should also be safely conducted, and minimise or eliminate harms linked to helathcare. People-centric quality healthcare is also key, and healthcare practitioners should strive to engage individuals, families and communities with a firm respect for specific cultural norms. Healthcare delivery should also be timely, equitable, integrated and efficient to the furthest extent possible, and seek to administer fair treatment without discrimination to background, while minimising wait times and resource use inefficiencies.

Steps and guidelines to quality healthcare improvement

This document will cover the general steps in quality healthcare delivery, and the plan, do, check and act model (PDCA). However, healthcare organisation management teams may also consider other models, such as failure modes and effects analysis, Six Sigma, Lean and root-cause analysis to improve the quality of healthcare delivery. (Hughes, 2008)

General steps in quality healthcare delivery

Quality healthcare delivery should comply with the following steps to ensure effective delivery.

Foremost, senior leadership of the healthcare organization should be committed to open sharing and continual improvement in the delivery of quality healthcare.

Secondly, people and teams in the healthcare organization should have a strong sense of ownership, and should be empowered to continually improve various processes at their own work levels.

Thirdly, the healthcare organization should work with families and communities to develop locally identified solutions. In particular, a 2018 study by Bombard et al found that healthcare organizations need to empower and involve patients beyond tokenistic patient feedback, in order to better inform patient and provider policies, and to improve service delivery and governance. (Bombard et al, 2018)

Fourthly, the healthcare organization’s management team should specifically delineate the roles and responsibilities of various team members.

Fifthly, the healthcare organization should continuously measure improvements in various quality healthcare delivery trials and adapt the organization accordingly to learn and improve past mistakes.

Finally, the healthcare organization’s management team should implement feedback and incentive policies to incentivise the correct behavior.

Plan, Do, Check, Act Model

The plan-do-check-act model is a useful tool for improving the quality of healthcare delivery, as it allows for gradual change management, effective problem solving, continuous improvements and a design-centric approach to healthcare. (Roberts and Yeager, 2004)

Foremost, healthcare organization managers should plan for the desired changes, setting specific targets and outcomes, such as a decrease in wait times or a decrease in patient mortality.

Secondly, the healthcare organization managers should implement a pilot test of the targeted change. This pilot test should be a small-scale trial that allows for discontinuation in the event of failure, while also allowing for the potential for results to be replicable on a larger scale.

Thirdly, the healthcare organization managers should check that the results of the pilot change are in line with the expected outcomes.

Finally, the managers should act to scale up the changes in the healthcare organization on a larger scale, and persist in tracking the changes and altering them as needed.

Useful measurement and evaluation tools

The measurement and evaluation tools that can be used to improve the quality of healthcare delivery are patient trials, organisation design, patient focus groups and data analytics.

Foremost, patient trials can be used to test different parts of the patient healthcare delivery process, such as diagnosis, registration, treatment plan preference sensing, and recommendations. In conducting patient trials, it is important that the trial management team ensure that patient safety and wellbeing is safeguarded, and that the trials are conducted ethically with minimal adverse impact to present healthcare delivery standards.

Secondly, organisation design can be used to structure the organisation around the needs of different stakeholders, such as patients, financial institutions, families and healthcare practitioners. In particular, it is important to allow different stakeholders the space to co-lead healthcare delivery improvements.

Thirdly, patient focus groups can be used to assess patient opinions about different health care issues, and to determine what are the needs most urgent for patients in order to formulate more effective healthcare delivery mechanisms. In conducting focus groups, it is important for healthcare organisation teams to structure questions in a way that elicits genuine feedback rather than soliciting pre-determined responses from patients. The use of democratic dialog, third party facilitators and safe spaces will also increase the quality of feedback received in the focus group process.

Finally, data analytics in the form of healthcare procedure fees, patient survey scores, wait times and other variables can be used to assess where inefficiencies and areas for improvement are in the system. The use of predictive analytics and artificial-intelligence driven systems can also allow for better decision making by the healthcare organisation’s managerial team, as data collected in the healthcare delivery process can be analysed and used to make better decisions in healthcare process reform. However, it is important to complement qualitative methods with quantitative methods in conducting data analysis.

Implementation process

During the implementation process, it is important for the healthcare organisation team to ensure accountability, safety, and quality assurance. Furthermore, the implementation process should include verifiable and measurable ways to track improvements to the quality of the healthcare delivery process. The implementation process must also include ways for the reformed processes to be changed or adapted, should it be observed that the present reforms are ineffective or have unintended consequences. Healthcare organisations must also be keen to question previous assumptions and processes when implementing healthcare delivery process reform, and to focus on improving the quality, efficiency, resource use and safety of healthcare delivery, with the potential need to prioritise some metrics over others in the final implementation. Finally, healthcare organisation management teams should be aware of technical and financial limitations, such as budget constraints, when implementing healthcare reform, and scale or alter the process of healthcare delivery reform accordingly to be in line with such constraints.

Project Case Study

The project case study of successful quality healthcare delivery reform is the case study outlined in George et al, 2014, entitled ‘Delivery and payment reform in congestive heart failure at two large academic centers.’ In this case study, the healthcare organisation team successfully reformed the payment and delivery system to allow for a transition from high-intensity, high cost inpatient care to a more holistic and integrated approach of prevention, coordination and management of the illness in outpatient and primary care settings. The reforms also involved the creation of alternative payment models that supported such integrated disease management, care coordination and other ancillary supportive mechanisms that were not then supported in a fee-for-service, volume-based traditional payment process system. Hence, the hospital implemented alternative payment models that consolidated all services incurred in an integrated manner, such as the Bundled Payment for Care Improvement (BCPI) initiative and the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations. (George et al, 2014)

These programs were successful as they incentivised healthcare practitioners to coordinate healthcare services in multiple delivery modes across longer timeframes, while allowing healthcare financiers such as insurance companies to be accountable for all patient services incurred, both inpatient and outpatient. Furthermore, they gave financial incentives for the use of a more comprehensive range of healthcare delivery options, which ultimately improved the overall quality of care administered to patients.

Conclusion

In covering the background principles of quality healthcare delivery, steps and guidelines for effective healthcare delivery, useful measurements and evaluation tools, implementation processes, and a case study of quality healthcare delivery, this document serves as an important practical guide for healthcare providers and healthcare practitioners to improve the quality and care of healthcare delivery.

References

Berman, P., Pallas, S., Smith, A. L., Curry, L., & Bradley, E. H. (2011). Improving the delivery of health services: A guide to choosing strategies.

Bombard, Y., Baker, G. R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., & Pomey, M. P. (2018). Engaging patients to improve quality of care: a systematic review. Implementation Science, 13(1), 98.

George, M., Bencic, S., Bleiberg, S., Alawa, N., & Sanghavi, D. (2014, July). Case study: Delivery and payment reform in congestive heart failure at two large academic centers. In Healthcare (Vol. 2, No. 2, pp. 107-112). Elsevier.

Hughes, R. G. (2008). Tools and strategies for quality improvement and patient safety. In Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US).

Roberts, A. R., & Yeager, K. R. (2004). Evidence-based practice manual: Research and outcome measures in health and human services. Oxford University Press.

World Health Organization. (2018). Improving the quality of health services: tools and resources.