Improving the quality of health care through contracting: a study of health authority practice.

نویسندگان

  • J D Gray
  • L J Donaldson
چکیده

OBJECTIVES To investigate approaches of district health authorities to quality in contracting. DESIGN Descriptive survey. SETTING All district health authorities in one health region of England in a National Health Service accounting year. MATERIAL 129 quality specifications used in contracting for services in six specialties (eight general quality specifications and 121 service specific quality specifications) MAIN MEASURES Evaluation of the use of quality specifications; their scope and content in relation to established criteria of healthcare quality. RESULTS Most district health authorities developed quality specifications which would be applicable to their local hospital. When purchasing care outside their boundaries they adopted the quality specifications developed by other health authorities. The service specific quality specifications were more limited in scope than the general quality specifications. The quality of clinical care was referred to in 75% of general and 43% of service specific quality specifications. Both types of specification considered quality issues in superficial and broad terms only. Established features of quality improvement were rarely included. Prerequisites to ensure provider accountability and satisfactory delivery of service specifications were not routinely included in contracts. CONCLUSION Quality specifications within service contracts are commonly used by health authorities. This study shows that their use of this approach to quality improvement is inconsistent and unlikely to achieve desired quality goals. Continued reliance on the current approach is holding back a more fundamental debate on how to create effective management of quality improvement through the interaction between purchasers and providers of health care.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Improving Care for the Frail in Nova Scotia: An Implementation Evaluation of a Frailty Portal in Primary Care Practice

Background Understanding and addressing the needs of frail patients has been identified as an important strategy by the Nova Scotia Health Authority (NSHA). Primary care (PC) providers are in a key position to aid in the identification of, and response to frailty as part of routine care. Unlike singular chronic conditions such as diabetes and hypertension which garner a disease-based appr...

متن کامل

Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

Background Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding.   Methods Over an 18-month time period, staff applied a patient-cen...

متن کامل

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes

Background Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research ...

متن کامل

Explaining the Concept of Ethics in Home Health Care Nursing: Content Analysis

Introduction: Adherence of home care nurses to ethics in care, while improving the quality of nursing care, also improves patient satisfaction. Therefore, nurses must have ethical in care competency. The purpose of this study is to explain of ethical competency in care at home. Methods: The qualitative content analysis study is conventional that was conducted in home health care centers in Tehr...

متن کامل

Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands – A Study of 5 Elective Surgeries

Background Independent treatment centres (ITCs) are a growing phenomenon in many healthcare systems. Focus factory theory predicts that ITCs provide high quality healthcare with low prices, through specialisation, high-volume and routine. This study examines if ITC care outperforms general hospital (GH) care within a regulated compe...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Quality in health care : QHC

دوره 5 4  شماره 

صفحات  -

تاریخ انتشار 1996