Response/Reflection #4
Student Response #1
The domain that I believe to be the most significant of the three would be the process. This reasoning is being is that process entails the collection of all actions that encompass healthcare. In fact according to Donabedian (1982), the measurement taken on the process domain is almost equivalent to the measurement of the quality of care. This suggests strongly that the process domain is the most accurate reflection of the quality of healthcare that is being provided to the recipients. Receiving quality care is synonymous with receiving the correct care as well as efficient care; this is further evidence that the process stage is the most significant of the three. It could also be argued that the process domain is inclusive of the individual activities required for the purpose of healthcare delivery.
The activities that are carried out in within the process domain include treatments, preventive care, diagnosis, and patient/ family education (McLaughlin & Kaluzny, 2006). These activities are performed in order to promote recovery, restore function, increase survival, and increase the patient’s level of satisfaction (Ranji, Shetty, Posley, Lewis, Sundaram, Galvin, & Winston, 2007). Although I have identified the process domain as the most significant it is important to consider that processes rely on the structures for resources as well as the mechanisms used by the providers to care for patients. If the activities are carried out that results in a positive outcome then it can be determined that the structure in place is the correct one. The correct structure should result in the processes being carried out efficiently and effectively as a result of the dependent nature between the process and structure domain.
The process domain can be further classified into separate functions be represented by the interpersonal classification as well as the technical processes. The interpersonal processes can be described as the manner in which healthcare is delivered to the patient from the healthcare provider. The focus within this sub-process is the interpersonal interaction between patient and provider and the building of a strong relationship. This requires the establishment of trust through showing empathy, listening, and working in a collaborative fashion. Donabedian (1982) established that the technical domain was the application of medicine and health care science. This domain would include the equipment and the different systems and methods used in the delivery of healthcare to the people. The equipment and systems would then be compared against previously established criteria relating to technical, professional, and ethical standards. Data collected during interviews with patients and providers, as well as medical records or direct observations during healthcare visits, can be valuable sources of information about the process domain.
In my opinion, the least significant domain is the structure domain because it has the least effect with regard to outcome. There are many instances in which structure is changed many times to improve efficiency, while theoretically not affecting quality. The better argument would be that this domain is not any less significant but changes within this domain have less of an effect on positive outcomes than do the other domains. This is possible because the structure domain consists of elements such as medical equipment, staff training, payment methods, physical facilities, and human resources. These factors all contribute to the ability to deliver efficient and effective health care to the patient, but inherently allow for the widest range of variation between factors within the process. It could also be argued that the structure domain is the easiest to recognize and measure. This often allows for adjustments to be made quickly because problems within this domain are often also observed and measured first (Nelson, & Staggers, 2014).
Quality measures are quickly becoming increasingly sophisticated and other categories are beginning to supplement the existing domains of structure, process, and outcome. One of the most popular additions is the composite measure domain. Often the overall quality cannot be judged accurately as a sum of its combined parts. The composite measures domain allows the combining of multiple measures into a single unified score. This better allows patients, healthcare organizations, and researchers to get a better picture of the overall range of patient care. Composite measures are now widely being used by insurance companies as well as for promotion of high scoring facilities and providers (Dimick, 2010).
References
Donabedian, A., Wheeler, J. R., & Wyszewianski, L. (1982). Quality, cost, and health: an integrative model.Medical care, 975-992. Retrieved from http://www.jstor.org/stable/3764709?seq=1#page_scan_tab_contents
Dimick, Chris. Quality Check: An Overview of Quality Measures and Their Uses. Journal of AHIMA 81, no.9 (September 2010): 34-38. Retrieved from http://bok.ahima.org/doc?oid=101998#.WNDQVhiZNsY
McLaughlin, C. P., & Kaluzny, A. D. Continuous quality improvement in health care: theory, implementation and applications. 2006. Gaithersburg, Md: Aspen Publishers Inc, 3. Retrieved from https://books.google.com/books?hl=en&lr=&id=6pOyV0SDZ8MC&o
Nelson, R. & Staggers, N. (2014). Health informatics: an interprofessional approach. St. Louis, Mo.: Elsevier Mosby. Retrieved from http://www.worldcat.org/libraries/10142
Ranji, S. R., Shetty, K., Posley, K. A., Lewis, R., Sundaram, V., Galvin, C. M.,
& Winston, L. G. (2007). Closing the Quality Gap: A Critical Analysis of Quality
Improvement Strategies (Vol. 6: Prevention of Healthcare–Associated Infections).
Student Response #2
Learning from defects is a huge campaign that many hospitals are participating in including the one I work in. One motivational factor for these educational programs is that approximately 300 people die per day from avoidable medical errors in US hospitals (Vanteddu & McAllister, 2014). Improving patient outcomes is the goal of these initiatives. Measuring the quality of the product a healthcare institution produces is difficult due to multiple contributing factors. One example is the overall living standards of a population that surrounds a healthcare institution. Evaluating specific entities in how a health care system operates is a great place to start. An article written by Avedis Donabedian published in July of 1966 titled “Evaluating the Quality of Medical Care” outlines the quality of a healthcare system as a product of its structure, process, and outcome (Ayanian & Markel, 2016). This article presents information on how and what to assess when attempting to determine the quality of a health care organization.
The structure is described by Donabedian as what resources the organization has to operate. One example mentioned in his article is the training and qualifications of physicians and how it is directly related to the quality of care they provide (Donabedian, 1966). Hospital accreditation and dedication to investments in quality equipment are other indicators that define the strength of the organizational structure. The idea behind structure as a foundation for quality is because without resources, the processes that are delivered within an institution cannot be carried out. Procedures cannot be performed without adequate equipment. Funding to meet accreditation criteria is an indication of administration’s dedication to quality. To become accredited and organization must demonstrate that it requires licensure of its staff and/or prove it meets specific service levels. Criteria is dependent on what type of accreditation the organization is attempting to secure. The question I always ask myself is do I want a good surgeon performing a procedure on me or do I want a great surgeon performing the procedure. Working in a health care facility provides me with the opportunity to understand which physician I prefer for a particular procedure as a direct result of observed outcomes. The general non-medical population does not have this inside information. This is reason why health care organizations must focus on their structure to provide the fundamental best possible services. Structure is the foundation for the other domains noted in the model which is why its level of quality is imperative.
The process is the second most important domain because it defines the how the delivery of health care occurs in an organization. The process cannot occur without proper structure, but it is an extremely important piece when evaluating an organization. Complicated processes can set even the best health care provider up for failure. There are two sides to the process aspect regarding delivery technical and interpersonal (Shi & Singh, 2015). The manner in which a patient is treated is extremely important because compliant patients are patients that believe they have been treated well by their provider. Trust is won with care and compassion and when a patient believes in their health care provider they will follow instructions. Cancellation of surgical procedures is a huge issue in hospitals. Surgical cancellations occur for many reasons and is mentally harmful for patients that are anxiously awaiting for a procedure. Waiting times and accuracy of prescription delivery are all included in process improvements at many facilities. Patient satisfaction surveys are one method of determining where process issues are most prevalent at an institution.
Structure and process directly affect outcomes. Outcomes are a metric that can be measured easier than the process and structure. Readmission rates are one measurement that hospitals utilize to indicate issues with structure and process. Poor patient outcomes are studied immensely to determine where contributing factors occurred in the structure or process. Unfortunately this is a backwards way of doing things, but it is a process utilized to get data for improving structure and processes. My facility utilizes a system that requests all staff to report process or care issues. Our administration requests that we encourage staff to use this system with all issues to give us a good way to measure quality issues. It is a great system as long as the staff truly is using it. Our system was improved for ease of use last year and it has become a much more widely accepted reporting method.
References
Ayanian, J. Z., & Markel, H. (2016). Donabedian's lasting framework for health care quality. The
New England Journal of Medicine, 375(3), 205-207. Retrieved fromhttp://search.proquest.com.proxy.davenport.edu/docview/1806105238?accountid=40195
Donabedian, A. (2005). Evaluating the Quality of Medical Care. The Milbank Quarterly, 83(4),
691–729. http://doi.org/10.1111/j.1468-0009.2005.00397.x
Shi, L., & Singh, D. A. (2015). Delivering Health Care in America A Systems Approach (Sixth
ed., pp. 494 - 495). Burlington, MA: Jones & Bartlett Learning.
Vanteddu, G., & McAllister, C.,D. (2014). An integrated approach for prioritized process
improvement. International Journal of Health Care Quality Assurance, 27(6), 493-504. Retrieved from http://search.proquest.com.proxy.davenport.edu/docview/1660689036?accountid=40195
Student Response #3
Introduction
The donabedian model is represented by the structure, process, and outcome. It represents three types of information that is needed to draw conclusions about the quality of care in a given system. The improvement of the health care quality is the expected end result of the implementation. The model consists of Structure, process, and outcome (Models of health care quality, 2017). Structure is physical and the organizational chacterstics, process is the focus on the care delivered to patients, and outcome is effect of health care on the status of patients and population (Models of health care quality, 2017)
Discussion
A study was done and showed that the Donabedian model can really help with the health care system. A questionnaire was developed and sent to a random sample of 600 hospitals in Sweden. The results found that the model with relationships between structure, process and outcome was found to be reasonable to represent the quality systems within hospital departments and the model could be used to describe and evaluate and compare various systems and help to improve the quality ( Kunkel, S & Rosenqvist, U & Westerling, R, 2007). This was just an example to show that the model really does have benefits to it if we use it properly.
I think from the 3 domain, the process is the most significant. Because the better the patients are treated, the better the overall health care results will be. That’s the most important goal that affects everything. I think sometimes administration forgets that and all they care about is money and the net coming in. If the patients don’t get the right treatment, that money will go downhill really fast and no time to recover. Honestly, there’s no domain that that is really least significant. I find all of them pretty critical for the system to work. That’s why I really don’t think any other domain needs to be added to make it better. I think the overall set up is very well.
Conclusion
In general, I think the donabedian model is set up pretty well to determine how good our health care system is. It consists of structure, process, and outcome. I believe all 3 are very important to determine the success of the quality system and using it the right way can give out really good results for the future.
References:
Models of Healthcare quality. “International centre for Allied Health Evidence”. 2017. Retrieved fromhttp://implementationcentral.com/ebponline/?page_id=340
Kunkel S, Rosenqvist U, Westerling R. The structure of quality systems is important to the process and outcome, an empirical study of 386 hospital departments in Sweden. BMC Health Services Research. 2007;7:104. doi:10.1186/1472-6963-7-104.
Student Response #4
Healthcare system in United States is deviating their quality of care based on the cost spend by the patient or patient insurances. The contribution of the healthcare system to the GDP of United States is exponentially higher, as the GDP contribution is higher is harder to change the healthcare system. For example, “United States uses a larger percentage of economic resources on health care 2009, 17.4% of GDP was spent on health care $7,960 per capita 2015, 20% of GDP projected to be spent on health care”(Shi 2015). As it has shown the healthcare contribution to the GDP of the nation, and how much it has been increase in last six years. According to the Donabedian Quality Improvement Framework model is based on the evaluating the certain factors that can influences the cost and quality of care in healthcare system. This model deals from structure to the service in healthcare industry.
The main goal of this model is provide the good care with least expensive or innovative way to patients, where cost should be not related to the quality of care. According to study, “This study demonstrated that the Donabedian framework of Structure, Process and Outcome evaluation is a valuable and validated approach to examine the safety and quality of a service innovation. Furthermore, in this study, specific Structure elements were shown to influence the quality of service processes further validating the framework and the interdependence of the Structure, Process and Outcome components”(Gardner 2013). It shows how the Donabedian framework works with quality of care along with the cost of the care. It does include certain factors to ensure the quality of care is not comprised with cost of care. Having these models in healthcare will provides checks and balances in healthcare system. Knowing these checks and balances in healthcare industry by healthcare professionals’ will ensure the quality of care to the patients.
Additionally just having these models will show the transition in healthcare from traditional methods to modern methods, with the help of research and many more factors. These models also allows healthcare professional to predict the results of biopsychosocial outcome of the patients regarding their care and physicians professionalism while dealing with the patients. For instances, “Existing conceptual models do not sufficiently address the significant interrelationships amongst variables to explain, predict and/or control AEA-SHCN's biopsychosocial HCT outcomes. This article provides a description of a health care transition theoretical model developed by the international and interdisciplinary Health Care Transition Research Consortium (HCTRC) that can be applied for testing in research and serve as a framework for clinical practice and policymaking”(Cecily 2014). Above quotes shows how these models have changed the disciplinary in the healthcare system in United States. Knowing these models in theory and implementing them in practically is tough task. However these models provide the base for healthcare system should be while treating patients.
Finally, any model in healthcare system including Donabedian Quality Improvement Framework model is to provide the best quality of care to patients. Quality of care should not be comprised or equated to the cost of care for patients. However due to the huge contribution by healthcare towards GDP of United States, it is getting harder not to include the cost of healthcare system while quality of care towards patients is questionable. It is every healthcare professional responsibility to provide the good quality of care to their patients, while providing good of care to their patients and proving it to the healthcare system might eventually shift the gears form cost of care to the quality of care for patients. This was the main aspect of Donabedian Quality Improvement Framework model in healthcare system.
References
Cecily Q. (2014, December 11). The health care transition research consortium health care transition model: A framework for research and practice. Retrieved March 28, 2017, from http://content.iospress.org/articles/journal-of-pediatric-rehabilitation-medicine/prm00277
Gardner G. (2013, July 3). Using the Donabedian framework to examine the quality and safety of nursing service innovation. Retrieved March 28, 2017, from http://onlinelibrary.wiley.org/doi/10.1111/jocn.12146/full
Shi. L. (2015). Delivering Healthcare in America in systematic approach. 6th ed Retrieved March 28, 2017,https://docs.google.com/presentation/d/1uUFd6_qloo7BafWYz7iAsQfGP8O4we149X0ZES4ToWw/edit#slide=id.p4