Introduction to Health Care Quality: Theory, Methods, and Tools

Book Preface

When I began to think about revising the outdated Quality Handbook for Health Care Organizations: A Manager’s Guide to Tools and Programs (Jossey-Bass, 2004), my goal was to introduce and explore the many changes that have made an impact on health care in the last decade. I quickly realized that I couldn’t simply revise the book for a second edition; too much had changed. An entirely new book introducing quality management was needed if I wanted it to be of value to health care professionals and students. This Introduction to Health Care Quality: Theory, Methods, and Tools seemed necessary. Even the change in titles is revealing. Quality is no longer the sole purview of managers. To the contrary, now everyone—clinicians, administrators, executives, patients—involved in health care services needs to work within a quality framework and be familiar with quality management processes. Students who hope to work in health care, whether in the clinical, administrative, or policy-making roles, need to know the fundamentals of quality management to succeed. Physicians, nurses, pharmacists, and public health policy makers all need to involve themselves in performance improvement activities and understand how to transform data into useful information in order to take action. Administrators and executives have to meet the goals of specific quality measures set by government agencies in order to be reimbursed for the delivery of care and medical services.

My books are designed to be of practical use to students and professionals and are based on my experience working in the field of quality management for decades and teaching fundamentals of quality all over the world. I have the good fortune of being part of a vast health care system that encompasses the entire spectrum of health care services—21 hospitals, the Feinstein Institute for Medical Research, the Krasnoff Quality Management Institute, the Center for Learning and Innovation, rehabilitation and skilled nursing facilities, a home care network, a hospice network, and progressive care centers—offering a range of outpatient services; ambulatory facilities; psychiatric care; long-term nursing care; and children’s organizations. Thus I have direct and immediate access to the issues that most concern administrators and executives, floor and unit managers, clinicians, policy makers, IT professionals, and others. Writing from personal experience gives me the opportunity to share practical issues of quality in action and relay the direct application of quality management theory, methods, and tools.

I have always been a champion of quality and I like to think an advocate for patients’ rights and patient safety. I have worked diligently to ferret out gaps in care and potential gaps in safety to improve performance, and further communication and accountability across the hospital and the continuum of care. I followed this path because I believe in the tenets of quality management; I believe in the objectivity of data to make a case for good or poor care. I believe in numbers, in measurements, in tracking improvements and interventions over time using reliable and valid data.

But it was not until I myself became a patient that my theoretical expertise quickly became of immediate and practical concern. As a patient, I found myself vulnerable to issues of safety and communication failures that I had written about and spoken about but had never directly experienced. Although I had always understood the importance of patient identification, for example, until I was receiving chemotherapy and the nurses made absolutely sure that I was getting the correct dose of the correct medications in the correct manner, and asked me multiple times to confirm my name, I didn’t realize how reassuring it was to know that the procedures developed to ensure proper patient identification were in place and being followed.When I needed my MRI results to be transmitted to my oncologist in a timely fashion, I didn’t want any failures of communication to take place. Ensuring quality care became deeply personal.

And although I am probably better educated than most about dealing with health care data, I found that when I was confronted with three very different plans of care from three very highly regarded physicians, I needed to understand mortality rates and complications from treatment, numbers, variation, and evidence in a new way. How many patients with my particular very rare cancer had each doctor treated and with what outcome? I realized how valuable my experience as a quality professional was. I knew what questions to ask. Quality care is, of course, a goal for organizations to strive for, but it is also for everyone. I realized that everyone—health care professionals, patients, and potential patients—should be quality managers. This book, then, is for everyone.

New models of health care are so-called patient-centered, making patients central to the care plan and treatment process. Again, to me, this is no longer theory. It is in fact critical that patients understand what is happening to them, why they are having the treatment they are having, what the predicted outcomes will be, and what complications might occur. All these issues, basic to quality management, were now basic to me. All patients should indeed be treated holistically. We are not defined by our disease or our illness; we are people with psychosocial experiences and needs, some of us more capable than others or simply luckier than others in being able to take good care of ourselves.

Everyone should be a quality manager. Everyone will have occasion to interact with a health care delivery system of one kind or another, either for themselves or for family and loved ones. Everyone needs to be schooled about quality, how to assess care, what to look for, what is expected, what should not be tolerated. Everyone should be an advocate for quality care. I hope this book will be useful to professionals and nonprofessionals alike.