A new white paper “House of Quality: A Blueprint For Quality”, from the international hospital accreditor Joint Commission International (JCI) offers a path for quality improvement. The paper equates cultivating an effective quality programme to building a house. It requires intentional planning with an integrated approach that takes into consideration people, processes, and technology.
Despite advancements made in healthcare over the past decades, JCI continues to observe significant gaps in quality and safety. Organisations have adopted quality concepts from other industries, yet the results fall short.
The goal of the new blueprint is to achieve quality results. Despite years of research there is not a single, common definition for health care quality. Quality includes safety; timeliness (which includes accessibility and affordability); efficiency; effectiveness; equity and is person-centred. These and other attributes are used as a framework to define and measure quality of care.
Quality has been defined as meeting or exceeding the customer expectations. However, in health care, there are often multiple customers; therefore, the definition of quality depends on the perspective of the stakeholder involved.
From the patient perspective, quality is defined by what is important to them: their clinical results (safe and effective) as well as their experience while receiving care. From the provider or payer perspective, the performance of the system – such as efficiency – is also critical.
Healthcare is a field of continuous learning and advancement, where change and innovation are the norm. Therefore, achieving quality care is not a fixed or static goal. Healthcare providers must keep up with and incorporate the most current evidence- based medicine to provide quality outcomes. Organisations must apply this same approach to their non-clinical areas, assuring up-to-date administrative systems, equipment and processes that support the provision of quality care.
Patient safety has emerged as a central, and separate, aim. The discipline of patient safety has evolved to focus on preventable, or avoidable, harm. The World Health Organization describes patient safety as the cultures, processes, procedures, behaviours, technologies, and environments in healthcare that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce its impact when it does occur. Like the broader field of quality, safety terminology and definitions are not standardized across the globe, which challenge the development of a common approach to improvement.
A strong quality programme includes the structures covering leadership and culture, teams and technology, and the processes, namely the methods and tools of improvement, to achieve the desired outcomes of high-quality, safe care. JCI uses the analogy of building a ‘house of quality’ to describe the necessary infrastructure for a healthcare quality programme that is aligned with the JCI standards.
The paper concludes that the healthcare community needs to adjust and innovate: set the vision where ALL are safe, ALL the time; apply the tools known to be effective, such as quality improvement and accreditation; and leverage technologies to address deficiencies in systems.
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