Traditional Monitoring & Evaluation practices in healthcare often focus on the following:
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| Traditional Monitoring & Evaluation |
Clinical aspects of care only: This narrow focus neglects other important factors that affect patient outcomes, such as governance, management, support services, and clinical processes.
Compartmentalization of QA activities: M&E activities are often siloed within departments or disciplines, rather than being aligned with the flow of patient care. This can hinder coordination and integration of care.
Focus on individual performance: M&E often focuses on identifying and correcting individual errors, rather than examining how entire processes can be improved. This approach can overlook systemic issues.
Reactive approach to improvement: M&E often only triggers action when a problem is identified. A more proactive approach would involve continuous improvement efforts.
Separation of quality dimensions: M&E often assesses appropriateness, effectiveness, and efficiency separately. A more holistic approach would integrate these dimensions to improve patient outcomes and care delivery efficiency.
Value-Based Healthcare System
A value-based healthcare system aims to provide high-quality care at a lower cost. This approach is based on the following principles:
- Transparency: Patients should have access to information about the quality and cost of healthcare services so they can make informed decisions.
- Compatible definitions and measures of value: All stakeholders should agree on common definitions and measures of value to ensure alignment and progress.
- Collaboration among stakeholders: Providers, payers, employers, insurers, governments, and consumers must work together to achieve value-based care.
The HHS proposes four cornerstones for value-based healthcare improvement:
1. Develop interoperable health information technology (HIT): Sharing electronic health record (EHR) information requires interoperability, which necessitates national HIT standards and a certification process.
2. Measure and publish quality information: Develop clinical practice guidelines and performance measures to compare healthcare providers for transparency.
3. Measure and publish price information: Collect price information from insurers and payers to enable consumers to make informed price comparisons.
4. Promote quality and efficiency of care: Offer price and quality information incentives to consumers and pay-for-performance incentives to providers.
W. Edward Deming's 14 Points for Managing Quality
W. Edward Deming's 14 Points for Managing Quality can be applied to healthcare to improve the quality of care provided to patients. These points emphasize the importance of continuous improvement, leadership, and employee engagement.
Conclusion
Traditional M&E practices in healthcare have limitations that can hinder quality improvement efforts.
A value-based healthcare system, along with principles like those outlined by Deming, offers a more comprehensive and effective approach to achieving high-quality, cost-efficient care.