Eleanor Finch
The Institute of Medicine (IOM) has developed a framework for quality assessment in the healthcare system, encompassing six aims: safety, effectiveness, patient-centredness, timeliness, health literacy, and cultural competence. IOM's work highlights the importance of safe and effective practices, patient-centred care, and timely interventions. Their 2000 report, To Err Is Human, revealed an alarming number of medical errors, underscoring the critical need for quality improvement. IOM's subsequent report, Crossing the Quality Chasm, called for a redesigned healthcare system, emphasizing the integration of health literacy, cultural competence, and language access services. Healthcare organizations strive to provide safe and quality care, but medication errors and other challenges persist, necessitating continuous improvement. Educational strategies, such as the Plan-Do-Study-Act (PDSA) cycle, play a pivotal role in training students to enhance patient safety and quality through audits and improvement initiatives.
| Characteristics | Values |
|---|---|
| Safe | Avoiding harm to patients from the care that is intended to help them |
| Effective | Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively) |
| Patient-centered | Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions |
| Timely | Reducing waits and sometimes harmful delays for both those who receive and those who give care |
| Equity-based | Reducing health disparities and increasing health equity |
| Accountable | Ensuring quality and accountability by assessing organizational system responses to health literacy and the availability of needed language access services |
| Data-driven | Using data to monitor the outcomes of care processes and using improvement methods to design and test changes to continuously improve the quality and safety of health care systems |
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What You'll Learn
- Safe: avoiding harm to patients from intended care
- Effective: provide evidence-based services to those who will benefit
- Patient-centred: care is respectful and responsive to patient preferences
- Timely: reduce waits and harmful delays for care
- Equity-based: address health inequities with collaborative efforts
Safe: avoiding harm to patients from intended care
The Institute of Medicine's (IOM) framework for quality assessment in healthcare includes six aims, one of which is "Safe: Avoiding harm to patients from the care that is intended to help them". This aspect of the framework focuses on patient safety and aims to prevent harm caused by the care they receive.
The healthcare sector is a complex environment, and medication errors are the most common type of mistake, causing over 7,000 deaths annually in the US, according to an IOM report from 2000. To address this, healthcare systems are mandated to demonstrate strong leadership to create a culture of safety. This approach holds both the organisation and individuals accountable for patient safety.
Healthcare professionals can use quality improvement audits and the Plan-Do-Study-Act (PDSA) cycle to improve patient safety. Students can be educated to identify the potential impact of quality improvement measures and evaluate evidence-based practices. Root cause analysis can also be used to identify human influences on medication errors and differentiate between best practice and local practice.
The IOM's framework helps consumers understand the meaning and relevance of quality measures. When consumers are given a clear and concise explanation of safety, effectiveness, and patient-centred care, they value these categories. This understanding helps them relate quality measures to their own experiences and expectations of healthcare.
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Effective: provide evidence-based services to those who will benefit
The Institute of Medicine (IOM) has developed a framework for quality assessment that includes six aims for the healthcare system. One of these aims is "Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit".
This competency of quality improvement focuses on ensuring that healthcare services are provided based on scientific evidence and knowledge. It involves using data and research to guide clinical decisions and practices, with the goal of improving patient outcomes. It also entails refraining from providing unnecessary or inappropriate services that are unlikely to benefit the patient, thus avoiding misuse and underuse of healthcare resources.
To achieve this competency, healthcare professionals should stay up-to-date with the latest scientific research and evidence-based practices in their field. They should integrate this knowledge into their clinical decision-making, ensuring that patient care is guided by the best available evidence. Additionally, healthcare organizations should encourage a culture of continuous improvement, where data is used to monitor patient outcomes and drive changes that enhance the quality of care.
Quality improvement initiatives, such as root cause analysis and Plan-Do-Study-Act (PDSA) cycles, can be employed to identify areas for improvement and test changes in a systematic manner. By involving healthcare professionals and students in these initiatives, organizations can foster a sense of ownership and encourage the adoption of evidence-based practices. Furthermore, collaboration with patients and respect for their preferences, needs, and values is essential to ensure that the services provided are effective and beneficial to the individual.
Overall, by adhering to the IOM competency of "Effective" services, healthcare organizations and professionals can improve patient outcomes, reduce healthcare costs, and enhance patient satisfaction by providing evidence-based, beneficial services while avoiding the misuse and underuse of healthcare resources.
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Patient-centred: care is respectful and responsive to patient preferences
The Institute of Medicine (IOM)'s framework for quality assessment in healthcare includes six aims, one of which is being "patient-centred". This entails providing care that is respectful and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
IOM's 2001 report, "Crossing the Quality Chasm: A New Health System for the 21st Century", concluded that healthcare safety and quality problems required a redesigned healthcare system. This report recommended six aims for improvement, including patient-centred care. Patient-centred care is about more than just the clinical encounter; it also includes the patient's experience with the healthcare system as a whole. This includes factors such as health literacy, language access, and cultural competence.
Health literacy interventions have been suggested as an approach to delivering high-quality healthcare. The Department of Health and Human Services (HHS) has emphasised the importance of ensuring that health information and services can be understood and used by all Americans. This requires skill-building with both healthcare consumers and professionals. A 2009 IOM workshop reported that integrating quality improvement, health literacy, and disparities reduction emphasises the intersection of patient-centred and equitable aims.
IOM's framework makes it easier for consumers to understand the meaning and relevance of quality measures. When consumers are given an understandable explanation of safe, effective, and patient-centred care, they view all three categories as important. Providing a framework for understanding quality helps consumers value a broader range of quality indicators.
Quality improvement initiatives can be incorporated into clinical education to improve patient safety and care. For example, students can be educated on how patient safety may be improved through quality improvement audits and the Plan-Do-Study-Act (PDSA) cycle. Students can also be instructed to seek information about quality improvement projects, evaluate evidence-based practices, and identify the potential impact of quality improvement measures on patient care. Ultimately, small unit changes, such as these, can improve patient care without needing to make institutional changes.
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Timely: reduce waits and harmful delays for care
The Institute of Medicine (IOM) has developed a framework that includes six aims for healthcare systems to improve quality. One of these aims is to ensure timeliness in healthcare services by reducing waits and harmful delays for care recipients and providers.
The IOM's framework is influential in guiding quality assessment initiatives in both the public and private sectors. The "Timely" aim is crucial as it recognises that delays in receiving care can be detrimental to patients' health and well-being. This aim is not just about reducing wait times but also about minimising potential harm caused by delays.
To achieve this, healthcare organisations should strive to identify and address potential errors and system flaws that contribute to delays. For instance, medication errors are a common type of mistake that not only impacts patient safety but also increases healthcare costs due to lost wages, disability, and lost productivity. By addressing such issues, healthcare systems can improve the timeliness of care and reduce the negative consequences of delays.
Quality improvement initiatives, such as QSEN Competency #6, emphasise the role of nurses and small unit changes in enhancing patient care. Clinical teaching strategies that incorporate quality improvement projects and the Plan-Do-Study-Act (PDSA) cycle can educate students and healthcare professionals on improving patient safety and reducing delays. Root cause analysis is a valuable tool in understanding human factors influencing medication errors and other delays, helping to design and test changes for better timeliness.
Additionally, health literacy, cultural competence, and language access interventions are suggested approaches to enhance the quality of healthcare. By integrating these domains and aligning them with individual skills and abilities, healthcare systems can improve timeliness and reduce health disparities. Providing understandable health information and engaging in skill-building with healthcare consumers and professionals are essential steps towards achieving timely and equitable care.
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Equity-based: address health inequities with collaborative efforts
The Institute of Medicine (IOM) has outlined six aims for improving healthcare quality, which include ensuring patient safety, providing effective and patient-centred care, and timely treatment. These aims form a framework that helps consumers understand the meaning and relevance of quality measures in healthcare.
Equity-based healthcare improvement aims to address health inequities and reduce health disparities by integrating health literacy, cultural competence, and language access services. Health literacy interventions are crucial, as they ensure that health information and services are accessible and understandable to all. For instance, the Department of Health and Human Services (HHS) emphasizes that public health professionals and systems are primarily responsible for improving health literacy and engaging in skill-building with health consumers and professionals.
Cultural competence training is another essential aspect of equity-based improvement. By educating healthcare professionals about the social determinants of health and cultural competence, disparities in health outcomes can be reduced. For example, a study by Butler et al. (2016) found that improving cultural competence led to reduced health disparities.
Additionally, language access services, such as providing qualified interpreters, are necessary to ensure equitable care. The National Committee for Quality Assurance (NCQA) has recommended integrating health literacy, language access, and cultural competence measures to improve overall quality and accountability in healthcare.
To address health inequities effectively, collaboration between healthcare institutions is vital. For instance, West Side United (WSU) in Chicago was formed through the collaboration of multiple healthcare organizations to reduce the life expectancy gap between neighbourhoods. WSU's success demonstrates the power of cross-sector partnerships and place-based strategies in advancing equitable health outcomes.
In conclusion, equity-based healthcare improvement requires collaborative efforts to address health inequities and reduce disparities. By integrating health literacy interventions, cultural competence training, and language access services, healthcare organizations can provide more equitable and patient-centred care, ultimately improving the quality of healthcare for all.
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Frequently asked questions
The IOM is the Institute of Medicine.
The six aims are: safe, effective, patient-centred, timely, efficient, and equitable.
A quality improvement strategy is the Plan-Do-Study-Act (PDSA) cycle. This involves implementing a plan, studying its effects, and then acting on the findings.
IOM improves health equity by aligning healthcare system demands and complexities with individual skills and abilities. This includes attention to health literacy, culture, and language access services.
West Side United (WSU) in Chicago aims to reduce the 14-year life expectancy gap between the Loop and West Side neighbourhoods. They have built health and economic wellness initiatives with over 100 organisational partners to support vibrant communities.
