An Introduction to Quality Assurance in Health Care

by Donabedian, Avedis

• ISBN13: 9780195158090
• ISBN10: 0195158091
• Edition: 1st
• Format: Hardcover
• Copyright: 2002-12-26
• Publisher: Oxford University Press

Summary

Avedis Donabedian's name is synonymous with quality of medical care. He unraveled the mystery behind the concept by defining it in clear operational terms and provided detailed blueprints for both its measurement(known as quality assessment) and its improvement(known as quality assurance).Many before him claimed that quality couldn't be defined in concrete objective terms. He demonstrated that quality is an attribte of a system which he called structure, a set of organized activities whihc he called process, and an outcome which results from both. In this book Donabedian tells the full story of quality assessment and assurance in simple, clear terms. He defines the meaning of quality, explicates its components, and provides clear and systematic guides to its assessment and enhancement. His style is lucid, succinct, systematic and yetpersonal, almost conversational.

Table of Contents

List of Appendices	p. xxi
Introduction	p. xxiii
What This Book Is About	p. xxiii
The Meaning of Quality Assurance	p. xxiii
The Targets of Quality Assurance	p. xxiv
The Components of Quality Assurance	p. xxv
The Quality Monitoring Cycle	p. xxvii
Formal and Informal Monitoring	p. xxviii
Some Foundations of Quality Assurance Through Monitoring	p. xxix
The Meaning of Quality in Health Care	p. xxxi
The Components of Quality in Health Care	p. 3
Efficacy	p. 4
Effectiveness	p. 5
Efficiency	p. 9
Optimality	p. 11
Acceptability	p. 18
Choosing a Definition of Quality	p. 24
Steps in Monitoring and Improving Clinical Performance	p. 26
Determining What to Monitor	p. 29
Externally Required Monitoring Activities	p. 30
Internally Motivated Monitoring Activities	p. 30
Determining Priorities in Monitoring	p. 39
Importance to Patient Welfare	p. 40
Additional Institutional Interests	p. 40
Feasibility	p. 42
Selecting Approaches to Assessing Performance	p. 45
Definitions of Structure, Process, and Outcome	p. 46
Comments on the Structure-Process-Outcome Model	p. 47
Relative Usefulness of the Three Approaches	p. 49
Conclusions About the Choice of an Approach	p. 56
Formulating Criteria and Standards	p. 59
Definitions of Terms	p. 60
Importance of Criteria and Standards	p. 61
Some Attributes of Criteria and Standards	p. 61
Obtaining the Necessary Information	p. 77
Medical Records	p. 78
Surveys	p. 84
Financial Records	p. 86
Statistical Reports	p. 87
Direct Observation	p. 87
Test Situations	p. 89
Choosing When and How to Monitor	p. 91
When to Monitor	p. 92
How to Monitor	p. 93
Constructing a Monitoring System	p. 117
Key Elements	p. 118
Bringing About Behavior Change	p. 123
Readjustments in the System	p. 124
Educational and Motivational Activities	p. 126
The Effectiveness of Quality Monitoring	p. 133
Contextual Factors	p. 134
Operational Factors	p. 136
Some Concluding Remarks	p. 137
References	p. 139
Appendices	p. 145
Index	p. 197
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