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Highlights
•
“Quality care” definitions must encompass the perspectives of physicians, nurses and patients.
•“Quality care” judgments are mainly based on care processes, less on structures or outcomes.
•Successful communication and staff motivation are core indicators of high-quality care.
•“Hippocratic pride” in response to care successes constitutes a new quality care indicator.
•“Rapid reactivity” in response to [near] failures constitutes a new quality care indicator.
Abstract
Objective
Existing quality of care frameworks insufficiently integrate the perspectives of physicians, nurses and patients. We collected narrative accounts from these three groups to explore if their perspectives might add new content to these existing definitions.
Methods
Ninety-seven descriptions of “good” and “poor” care episodes were collected from a convenience sample of physicians, nurses and outpatients at eight regional hospitals. Two coders classified the narrative contents into themes related to structures, processes and outcomes of care.
Results
The physicians, nurses and patients raised the following “quality of care” aspects: Successful communication among staff, with patients and care companions; staff motivation; frequency of knowledge errors; prioritization of patient-preferred outcomes; institutional emphasis on building “quality cultures”; and organizational implementation of fluid system procedures.
Conclusion
Respondents primarily referred to care processes in their descriptions of “quality of care.” “Hippocratic pride” [in response to care successes] and “Rapid reactivity” [in response to [near] failures] emerged as two new outcome indicators of high-quality care.
Practice implications
This study provides a first qualitative fundament for understanding the components of “quality of care” from a triangulated frontline perspective. Future research needs to validate our findings with quantitative data to explore their usefulness for completing existing quality frameworks.
Keywords
Healthcare quality
Quality culture
Quality assessment
Quality improvement
Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
Cited by [0]
© 2021 The Author[s]. Published by Elsevier B.V.
In patient-centered care models, an individual’s needs and the desired health outcomes are the driving force behind all care decisions.
Healthcare professionals must practice patient-centered care – in which they anticipate the anxiety or fear that patients sometimes experience when receiving care – and take responsibility for comforting and reassuring their patients at every step, ensuring patients and their families and caregivers are at the center of everything they do.
As patients become more engaged with the delivery of their care, and evidence of its clinical efficacy continues to mount, technology and information delivery is also maturing. In the current environment, patients expect a high-quality experience, so a culture of patient-centered care isn't a "nice to have," it's a "need to have."
The importance of a patient-centered care model
A patient-centered care model encourages active collaboration and shared decision-making between patients, families, caregivers and providers. Here are some of the things to consider in delivering patient-centered care:
- Care is collaborative and coordinated and goes beyond physical well-being to also include emotional, social, and financial aspects of a patient’s situation.
- Patients should always be in complete control when it comes to making decisions about their own care and treatment.
- Clinicians are there to inform, advise and support, but it is ultimately up to the patient to determine what course of action they will take.
- Patients need to fully understand the procedures and treatments they will undergo, while clinicians must aim to make them as knowledgeable and comfortable as possible, especially when treating them for a complicated or painful illness or injury.
The value of evidence-based practice
Evidence-based practice is a widely used problem-solving approach in the clinical setting, but it's also crucial to delivering patient-centered care. It integrates clinical expertise with the latest and best research evidence, along with known patient values, in order to deliver the best possible patient care.
One of the most important elements of evidence-based practice in nursing is taking into account the needs and wants of the individual patient. We need to understand what's most important to our patients — what are their preferences when it comes to treatment options, and how do they define quality of life? All of these things come together to make up the definition of evidence-based healthcare
The link between evidence-based nursing and value-based care
In recent years, the healthcare industry has been moving toward a value-based purchasing [VBP] and a value-based care [VBC] model that reimburses based on healthcare outcomes instead of healthcare services. In a VBC model, healthcare providers are incentivized to make changes that improve care value — by practicing patient-centered care, evidence-based medicine, and empowering patients.
In order to transform how healthcare providers are reimbursed for services rendered, the Centers for Medicare & Medicaid Services [CMS] has itself introduced an array of VBC models, such as the Medicare Shared Savings Program, Next Generation ACO Model, and Pioneer Accountable Care Organization [ACO] Model. Private payers meanwhile, have, in turn, adopted similar models of VBC.
The measures for value-based reimbursements range from hospital readmissions to the patient experience. So, employing the evidence-based practice of taking the patient's needs and wants into account positively impacts patient engagement and thus reimbursements.
What is the goal of value-based care models?
The goal of a VBC program is to standardize healthcare processes through best practices. Although the U.S. healthcare system is unique from others around the world, the overall goal of healthcare is the same — to provide the highest quality, most cost-effective, evidence-based care that improves patient outcomes.
So, in the end, it's important to never lose sight of the fact that all patients deserve to be respected and must be at the center of focus during every healthcare encounter. Patients expect nurses and other healthcare professionals to be knowledgeable, competent, and confident, but also kind and understanding too. Nurses are ambassadors for their institutions, the profession, and for their patients.
For more about patient-centered care, watch Reimagining the Future: The Culture of Caring presented by From the Desk of the Chief Nurses on nursingcenter.com.
Learn how Lippincott Solutions supports evidence-based decisions and patient engagement at the point of care.