Health Care and Risk Management :- Risk management is about reducing the opportunity of errors. Its unique aims are to reduce errors that are expensive in terms of discomfort, damage, distress or disability to an particular person and to limit financial loss to an organization. Risk management achieves this through detecting, reporting, and centering actual or potential deficiencies in the process of care that, however small, could lead to a significant and costly mistake. Risk Management Programs therefore involve all aspects of work, production, and interactions within an organization and in health care this includes looking beyond clinicalcare. An established and well run risk management program contributes towards providing hospital care that is free of error and it makes a clear contribution to healthcare quality. The benefits to patients of care in a hospital whose treatment can be guaranteed to be as safe as possible are obvious. But healthcare and risk management program is only one of a clutch of programs whose aim is to improve quality of care, and reducing harm is only one aspect of healthcare quality. Linking health care and risk management programs with other quality initiatives will help to develop a coherent approach to quality improvement within a hospital or practice. This paper will expiate some of the Ideas and definitions of quality of care and examine the particular contribution of risk management with some other quality initiatives to improving different aspects of healthcare quality.
Quality of Care
What does it include? Healthcare quality is much more than a matter of technical or professional performance, but it is difficult to sum up the individual components of good quality care. Much care is to some extent a series of compromises, tradeoffs, and choices, made, in the best circumstances, by properly informed patients guided by knowledgeable healthcare professionals in safe and comfortable surroundings. Good quality care incorporates appropriate and competent technical care with opportunities for patients to make choices and to discuss concerns and fears, and it should result in an outcome appropriate to the problem. Even this long and cumbersome description excludes some important aspects of good quality care, such as fairness and access, and assumes much in the phrase “competent technical care” and says lithe about the organization of care.
Dimensions of quality
• Efficiency
• Effectiveness
• Acceptability
• Appropriateness
• Equity
• Access
Three classifications provide a useful frame-work for discussing quality of health care. The first, the basis of much work on quality improvement, is Donabedian’s classification of health care into its structure, process, and outcome components as targets for quality assessment. The second is the six dimensions of quality described by Maxwell as part of a discussion on the need for an integrated quality improvement program based on methodical assessment (box). The third, also from the work of Donabedian, considers health care in three parts: the technical aspects of care, the interpersonal aspects of care, and the amenities or the environment in which health care is provided. Of course, these classifications averlap, but each approaches the definition of quality of care differently and together they provide a more complete picture than each alone. By, combining structure, process, and outcome with the six dimensions of quality, a structure emerges that cache used to compile a series of questions about the quality of, say, an intensive care unit (box).’
Structure, process, and outcome
The structure of care describes the resources that combine to deliver care and includes all aspects of the environment of the hospital, clinic, Or practice premises where patients are then and treated. Structure includes the number and grades of staff as well as the number of beds, the number and configuration of clinics, and the availability and standard of equipment and other items necessary for delivering health cam. Clearly, some aspects of structure, although desirable, arc not crucial for good quality care and, conversely, bad care is quite possible within a well equipped hospital. The process of care refers to all the events, procedures, and actions included in the health care received. This includes assessments such as clinical examinations and investigations, clinical interventions such as prescription of a drug or an operation as well as outpatient appointments, and the processes of nursing care and therapy. The interpersonal aspects of care may also be considered part of the process of care.
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