Quality in Healthcare: Information for Action

The health sector is classified as a service industry, and as such, it is usually subject to the human factor, which is difficult to standardize. Taking into account the complexity of this sector, the systems that reduce the risks of care and service are considered under the category of Quality in Health Services, whose characteristics are based on the redundancy of processes, which reduce the risks of an activity that can quickly trigger fatal risks.

Undoubtedly, the quality and safety of services in the health industry must be an institutional and personal commitment of each individual who collaborates within a health system, in the knowledge that the patient, their family, a company, or someone else has placed their trust in attending their health in our facilities, and it is our responsibility to do so with the highest quality and safety to solve their problem as best as we can.

There are several ways to measure quality and safety in the hospital environment, one of which is based on the establishment of quality indicators, which summarize  relevant information that reflects the performance of the health system.

The Importance of Measuring Quality and Safety With Indicators

"What cannot be measured, cannot be improved." This premise by William Thompson Kelvin is often used to highlight the importance of defining indicators in different industries; and healthcare services should be no exception.

It used to be thought that healthcare services were infallible. However,  the COVID-19 epidemiological contingency made it clear that healthcare systems are highly complex and, therefore, susceptible to errors. Unlike other industries, errors related to medical care can have fatal consequences. This is why clinics and hospitals are — or should be — compelled to develop strategic frameworks to ensure the quality and safety of the services they provide.

The Institute of Medicine defines Quality in Healthcare as "the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." Additionally, it further defines quality as having the following six properties: Effectiveness, Efficiency, Equity, Patient-centeredness, Safety, and Timeliness. 

Among these domains, patient safety is particularly relevant. According to the World Health Organization, each year, 134 million adverse events occur in hospitals in low- and middle-income countries due to unsafe care, resulting in 2.6 million deaths, which is likely  one of the 10 leading causes of death and disability in the world.

The development of Quality and Patient Safety Key Performance Indicators (KPIs) allows healthcare organizations to evaluate the performance of the strategies deployed to ensure better services and provide a framework to compare medical practices between institutions. But, ideally, this information shouldn’t be kept solely for the organization.

Donald Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement, concurs that transparency can improve value in healthcare by two key pathways: engaging providers to improve their performance — improvement through changes in care — and helping the consumer make informed choices — improvement through selection.

Transparency of Indicators: Empowering Patients 

Few hospitals worldwide have voluntarily opted for transparency of indicators as a way to promote a patient safety culture. The quality and safety of care is TecSalud’s priority, which is why our institution has recently entered the transparency game in its two hospitals. In mid-2020, TecSalud began publishing four key patient safety indicators for public consultation: unplanned hospital readmission rate, unplanned surgical reinterventions, fall-related injury rate per 1,000 patient days, and the average time from first medical contact to device in cases of acute coronary syndrome (door-to-balloon time).  

Although a methodology for the definition and analysis of these indicators has not yet been standardized worldwide, it is possible to rely on external organizations to validate the process without running the risk of being judge and jury. TecSalud collaborated hand in hand with one of the Big Four to verify its methodology for measurement, analysis and data processing, and thus, increase the reliability of the information it shares with the community.

The commitment of organizations to provide safe and quality healthcare services should be supported by the definition of metrics that allow them to evaluate the effectiveness of their strategies. Sharing this information with providers, payers and consumers entails risks, benefits and opportunities, but overall, it is an ally for making informed decisions and having a notion of what they should know — and demand — when choosing a healthcare institution.

At this time when health has become a challenge, we consider the approach of quality indicators in public and private health institutions to be of great importance to strengthen the culture of quality and safety.

This is how TecSalud joins efforts to contribute to the transformation of medical practice in Mexico, and through these types of actions, such as the measurement and transparency of indicators, endorses its commitment to quality and safety in the care of its patients.

(With contributions from Belinda Flores, Quality Director at TecSalud)