NCC OBSTETRIC AND NEONATAL
QUALITY AND SAFETY - SECTION I
(STILL IN BUILDING PROCESS)
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
Healthcare quality improvement goals - ANSWER Domains of quality, Dimensions of quality
(Donabedian), and System goals
Domains of Quality - ANSWER 6 goals established by the IOM:
Domains of Quality - Timeliness - ANSWER Reducing waits and sometimes harmful delays for both those
who receive and those who give care
Domains of Quality - Effectiveness - ANSWER 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).
Domains of Quality - Patient Centered - ANSWER Providing care that is respectful of and responsive to
individual patient preferences, needs, and values and ensuring that patient values guide all clinical
decisions.
Domains of Quality - Efficiency - ANSWER Avoiding waste, including waste of equipment, supplies, ideas,
and energy.
Domains of Quality - Safety - ANSWER Avoiding harm to patients from the care that is intended to help
them.
Domains of Quality - Equitability - ANSWER Providing care that does not vary in quality because of
personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
, Dimensions of quality (Donabedian) - ANSWER Structure, process, outcomes. Donabedian notes that
each of the three domains has advantages and disadvantages that necessitate researchers to draw
connections between them in order to create a chain of causation that is conceptually useful for
understanding systems as well as designing experiments and interventions.
Dimensions of quality (Donabedian) - Structure - ANSWER Includes all of the factors that affect the
context in which care is delivered: the physical facility, equipment, human resources, and organizational
characteristics such as staff training and payment methods. These factors control how providers and
patients in a healthcare system act and are measures of the average quality of care within a facility or
system. Structure is often easy to observe and measure and it may be the upstream cause of problems
identified in process.
Dimensions of quality (Donabedian) - Process - ANSWER The sum of all actions that make up healthcare.
These commonly include diagnosis, treatment, preventive care, and patient education but may be
expanded to include actions taken by the patients or their families. Processes can be further classified as
technical processes, how care is delivered, or interpersonal processes, which all encompass the manner
in which care is delivered. According to Donabedian, the measurement of process is nearly equivalent to
the measurement of quality of care because process contains all acts of healthcare delivery. Information
about process can be obtained from medical records, interviews with patients and practitioners, or
direct observations of healthcare visits.
Dimensions of quality (Donabedian) - Outcome - ANSWER Contains all the effects of healthcare on
patients or populations, including changes to health status, behavior, or knowledge as well as patient
satisfaction and health-related quality of life. Outcomes are sometimes seen as the most important
indicators of quality because improving patient health status is the primary goal of healthcare. However,
accurately measuring outcomes that can be attributed exclusively to healthcare is very difficult. Drawing
connections between process and outcomes often requires large sample populations, adjustments by
case mix, and long-term follow ups as outcomes may take considerable time to become observable.
System goals - ANSWER How healthcare defines success as an industry - Population health, patient
experience, and healthcare. The IHI Triple Aim is a framework that describes an approach to optimizing
health system performance. It is IHI's belief that new designs must be developed to simultaneously
pursue three dimensions, which we call the "Triple Aim": Improving the patient experience of care
(including quality and satisfaction); Improving the health of populations; and Reducing the per capita
cost of health care.
System goals - Population health - ANSWER Evaluating global causes to keep people healthy
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