Quality Management

Quality measurement to determine the end result of a product was first used in industry. Large manufacturers used processes that lead to a consistent quality product and instituted guidelines for these processes to continue. Often trial and error was needed before the process that led to the quality product was determined. The guidelines were refined so that the quality product could be reproduced the same way every time.

Quality measurement in health care is based on some of the same concepts used in manufacturing. “The measurement of health care quality is a seemingly simple endeavor, beginning with the decision on what to measure, identifying the proper measures along with their respective data sources, and culminating in the analysis, aggregation, understanding and dissemination of the results.” (1) In healthcare it is difficult to determine processes that affected the outcomes and develop measurements that are applicable. Patients are not objects that can be manipulated to perform the same way under the same processes every time.

In 1966 a physician named Avedis Donabedian developed a model for quality measurement (2). The three part model is still used today. Structure, process and outcomes are the three pillars of the theory. Structure is the physical aspects that make care possible such as the number of hospital beds, adequate monitors, and supplies needed for patient care. The steps required for a successful blood transfusion are an example of process. Outcomes are the patient condition after the interventions. By studying and improving structure and process then patient outcomes should improve.

The advantage of the implementation of quality measurement systems is the incorporation of evidenced based medicine into the structure and processes used to treat patients. In theory, this would promote consistent care of the patient across all boundaries and outcomes would be the same every time. Currently, quality measures...