Chapter 5 Population Health Quality and Safety

Learning Objectives 1. Explain why it is difficult to monitor healthcare quality and safety at the population level. 2. Conceptualize how to measure quality and safety at a population level, using Donabedian’s matrix. 3. Explain the cause of variations in practice patterns across communities. 4. Describe how to address quality and safety issues in an ideal situation, using available data in a specified community.

Key Words Culture - pattern of shared basic assumptions—invented, discovered, or developed by a given group as it learns to cope with its problems of external adaptation and internal integration. Outcome - evaluation of how a system is performing. Process - measure of whether a system is functioning as planned. 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.

Key Words Relational coordination - coordination of work through relationships of shared goals, shared knowledge, and mutual respect. Safety - freedom from accidental injury. Structure - measure of an organization and its physical attributes as they relate to performance. Teamwork - a group of individuals, usually from different disciplines, who work together to drive and participate in improvement.

Difficulties in Measuring Quality and Safety from a Community Perspective in the US Health care is not delivered through and integrated system Mixture of public and private providers working in separate institutions Care is fragmented, with no single information system to tell us what is happening Care for people with many different health conditions is not coordinated

The Four Tenets of Population Health Quality and Safety 1.Health care delivery is focused on what will benefit the majority, i.e., population based 2.Providers and patients must have shared responsibility for quality and safety 3.Chronic care management is a natural place to start focusing on population health quallity and safety improvement 4.Population health quality and safety creates a framework for advancing health and wellness

Core Components for Success 1) organization 2) coordination 3) culture

Achieving and Epidemic of Health and Wellness Measuring health care quality and safety in the community, as best we can: Developing operational definitions of community indicators, within a framework Evaluating indicators for validity, reliability, acceptability, and cost Developing instruments and identifying data sources

Measure Potential Problem Areas Need to protect individual patient information Need to benchmark and compare Need to be sure definitions are consistent across institutions

Understand the Sources of Quality and Safety Errors in Problem Areas Understand root causes of errors, using appropriate tools and methods

Attempt to Improve Health Care Quality and Safety in a Defined Community Share information on problems among providers Identify who is the responsible community authority, and how it will ensure that the problem is addressed effectively

Re-measure and Sustain Improvements Frequent re-measurement is necessary to stabilize changes in the system

Conclusions The current health care delivery system is fragmented and decentralized Transformational change is needed to deliver population health through safe and high quality health care products and services