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Arch Hellen Med, 29(4), July-August 2012, 480-488


Quality in health care and its evaluation

A. Papakostidi,1 N. Tsoukalas2
1Department of Economics, University of Pireus, Pireus,
2Oncology Department, 401 General Military Hospital of Athens, Athens, Greece

Until the late 1970s, quality assurance in the healthcare field was restricted to research conducted by academic institutions, in contrast to industry where statistical methods had already been in use since the 1930s. Avedis Donabedian, in a review of papers published between 1954 and 1984, identified three pillars for quality assurance in health care: "Sound structures, good processes and suitable outcomes". Quality in health care is associated with effectiveness, efficiency and technical competence, as well as safety, accessibility and a patient-centred approach, on the basis of continuity of service. Quality can be measured, and it involves all aspects of the functions of departments, from staffing and management to clinical practice. According to the systems theory of Donabedian, healthcare services consist of three elements: Structures and staff (human resources, equipment, buildings, etc.), procedures (services) and the results of actions and services. In each category, there are quantitative characteristics that can be measured, such as training and years of experience, waiting times, accuracy of equipment, level of patient satisfaction, complication rate, etc. When the areas of interest for quality improvement are defined, then quality standards can be set, along with appropriate quality indicators and definition of actions of conformity. The main selection criteria for a quality indicator in the healthcare sector are its usefulness, validity, reliability, comparability, responsiveness and, finally, sensitivity and specificity. When procedures are written and clearly specified and the results of clinical practice are published, useful conclusions can be drawn, on which can be based both continuous improvement of everyday practice, and better compliance of the personnel. Application of a common methodology by different departments enables valid comparisons to be made and offers useful material for research. Finally, quality cannot be achieved without evaluation of performance, with the application of statistical methods in everyday practice, according to quality assurance procedures.

Key words: Criteria, Evaluation, Health services, Indicators, Quality.

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