Healthcare is one of the most significant spheres of human activity because it is the quality of provided medical care that affects the overall health of the nation, death and disease rates, etc. The overall quality of human life depends on the quality of medical care provided; this is why medicine is under constant governmental control. Several legislative regulations have recently been adopted in the USA because of the growing need for improvement and raising the quality of medical services. Each institution has to comply with a set of laws and should be reviewed by monitoring organizations in the process of its functioning, so being knowledgeable about healthcare quality improvement appears so important.
To ensure the continuous improvement of medical care services there was a Health Care Quality Improvement Act adopted in 1986 and dedicated to the issues worrying the government as well as the population of the country (Busey et al., 1994). The main aim of this act is to guide the improvement programs in health care establishments, impose penalties on institutions that do not correspond to the stipulated standards and do not care for the improvement of provided services. The act also presupposes the participation of physicians in the peer review – this means that all aspects of medical work will be subject to control and assessment (Busey et al., 1994).
Clinicians and patients become active participants of the quality improvement process – patients, as the main recipients of medical care, can report about some unqualified specialists if they consider appropriate (Busey et al., 1994). Thus, as Busey et al. (1994) state, physicians who correspond to all requirements and standards are protected against any monetary damages, i.e. lawsuits or complaints because of their proper certification.
Taking into consideration the way medical services are arranged and paid for in the USA, it is possible to suppose that quality improvement will also be understood differently by different stakeholders. As McLaughlin and Kaluzny (2005) state, four different types of quality improvement are chosen by a particular institution in the improvement process: localized improvement efforts, organizational learning, process reengineering, and evidence-based medicine and management. They concern different aspects of the medical institution’s functioning, so they are the subject of interest for stakeholders. Those interested in the process of reengineering deal with the investment of internal and external resources that will affect key organizational processes. If a problem arises in a certain sphere of the hospital’s functioning, then a localized improvement team may be created to find a solution to the problem. This way the quality of healthcare is defined by various stakeholders in various ways – this also concerns the government, insurance companies, or patients. As an example, one may think about quality improvement on the state level seen in research and innovation of medical procedures, the discovery of new medicine, or the application of progressive, more efficient treatment methods. Insurance companies and investors see the quality of medical care in the way their costs are efficiently spent, how the expenditures fit the output of the hospital etc.
The concept of quality improvement emerged long ago but at first, it was mostly focused on service peculiarities and correct allocation of resources, without getting deeper into the organizational processes. Anyway, nowadays quality improvement has evolved and appears to be a synonym of management (Teutsch & Churchill, 2000). Continuous quality improvement (CQI) is sometimes called total quality management (TQM) – these two terms do not differ much:
“TQM/CQI is a structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations” (McLaughlin & Kaluzny, 2005).
As it can be seen from the quotation, improvement is essential in the medical care sphere since it appears so vital for people’s lives. Besides, ever-increasing standards are the indispensable element of progress each country strives for in the process of its existence. This concerns education, social security, medicine, etc – these spheres are the precondition for human welfare.
However, having defined the importance of continuous quality improvement it is necessary to find out what aspects of a medical institution’s functioning need reviewing in the improvement process. According to the opinion of McLaughlin and Kaluzny (2005), TQM/CQI involves such activities as linking to key elements of the hospital’s strategic plan, the establishment of the quality council, arrangement of training programs, and mechanisms for detecting improvement opportunities, formation of improvement teams, etc.
One may thus conclude that the main body responsible for quality improvement is the medical institution itself. All processes, initiatives, and strategic plans should be generated within its borders and implemented there as well. Nonetheless, there is a set of institutions that control, regulate and guide improvement processes. It is the US Institute of Medicine (IOM) that helped establish the main criteria of quality and cost and published reports on preferable medical institutions. As for the direct assessment of quality improvement in a particular medical institution, such governmental bodies as the Joint Commission on Accreditation of Health Care Organizations (JCAHO) and National Committee on Quality Assurance (NCQA) (McLaughlin & Kaluzny, 2005).
References
Busey, R.C. et al. (1994). Practical implications of the Health Care Quality Improvement Act: antitrust analysis. American Bar Association.
McLaughlin, C.P., & Kaluzny, A.D. (2005). Continuous quality improvement in health care (3rd ed.). Jones and Bartlett Publishing.
Teutsch, S.M., & Churchill, R.E. (2000). Principles and practice of public health surveillance (2nd ed.). Oxford University Press US.