Quality vs Safety – Quality and Safety in Patient Care
ROJoson – 15feb12
Circa 1995s, I spelled out the universal goals in the management of a patient which consist of resolution of the patient’s health problem or concern in such a way that the patient does not end up dead, with disability, or with complication and in such a manner that the patient is satisfied and there is no medico-legal suit. I have been using these formulated goals in the management of my patients. I have also been telling my medical and surgical students to have these goals in mind whenever they treat patients. I have not called these goals as quality or safety goals, just simply goals in the management of a patient. It is only now as I prepare for a lecture on patient safety management to be held on February 12, 2015 that I come to realize that these goals are quality and safety goals. One can see the quality and safety components if I restate the goals as such: resolution of the patient’s health problem (quality) in such a way that the does not end up dead (safety), with disability (safety), with complication (safety) and in such a manner that the patient is satisfied (quality) and there is no medicolegal suit (quality).
In 1999, when I started my journey in hospital quality management system, my practice had been to have “safety” subsumed by the goal of quality service and patient care without spelling it out. It was only in 2010 when I was made aware by the assessors from Accreditation Canada International surveying Manila Doctors Hospital of the importance to have the “safety” goal spelled out.
So, what is the difference between quality and safety? Should the quality and safety goals be independent of each other?
Quality vs Safety (Agency for Healthcare Research and Quality)
Below is an excerpt from an article that gives a backgrounder on the evolution of safety from quality and attempts to differentiate the two. (Emmanuel L: What exactly is patient safety? Ahrq.gov 2008)
“Part of the challenge lies in distinguishing safety from quality, a line that remains important to some, while being dismissed by others as an exercise in semantics. In 1998, the IOM convened the National Roundtable on Health Care Quality, which adopted the following definition of quality that was widely accepted: “Quality of care is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” (Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA 1998; 280: 1000-1005.)
Health care quality problems were classified into three categories: underuse, overuse, and misuse, all of which the evidence shows are common. Misuse was further defined as the preventable complications of treatment. Although the IOM Roundtable was careful to distinguish misuse from error (the latter may or may not cause complications), the misuse category became a common reference point for conceptualizing patient safety as a component of quality.
In 2006, Leape and Berwick observed that, as attention to patient safety has deepened, the lines between the overuse, underuse, and misuse categories have blurred. “It seems logical,” they wrote, “that patients who fail to receive needed treatments, or who are subjected to the risks of unneeded care, are also placed at risk for injury every bit as objectionable as direct harm from a surgical mishap.” (Leape LL, Berwick DM. Five years after “To Err Is Human.” What have we learned? JAMA 2005; 293: 2384-2390.)
The National Patient Safety Foundation identified the key property of safety as emerging from the proper interaction of components of the health care system, thereby leading the way to a defined focus for patient safety, namely systems. (Cooper JB, Gaba DM, Liang B, et al. The National Patient Safety Foundation agenda for research and development in patient safety. Med Gen Med 2000; 2: E38.)
Its goal has been defined as: “[t]he avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the process of care.” (Vincent C. Patient safety. London: Elsevier; 2006.)
Quality vs Safety; Quality and Safety (Accreditation Canada International)
Quality is “the degree of excellence; the extent to which an organization meets clients needs and exceeds their expectations”. Key attributes of high quality healthcare systems, as defined by the Institute of Medicine (U.S.) include safety, timeliness, effectiveness, efficiency, equity and patient centeredness.
Patient safety is often considered a component of quality, thus, practices to improve patient safety improve the overall quality of care.
Quality vs Safety; Quality and Safety (Joint Commission International)
Quality and safety are inextricably linked. Quality in health care is the degree to which its processes and results meet or exceed the needs and desires of the people it serves. Those needs and desires include safety.
The Institute of Medicine defines quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
Patient safety emerges as a central aim of quality. Patient safety, as defined by the World Health Organization, is the prevention of errors and adverse effects to patients that are associated with health care. Safety is what patients, families, staff and the public expect. While patient safety events may not be completely eliminated, harm to patients can be reduced, and the goal is always zero harm.
The ultimate goals are quality of care and patient safety.
ROJoson’s Summary Statements: There is a difference between quality and safe patient care. Safety is within the quality dimension. It is recommended for the safety goals to be extracted from the quality goals for emphasis reason. However, the ultimate goals should still be an alignment and integration of quality and safety in patient care.