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Creating Workforce Joy and Well-Being
Begins September 13, 2023 | Online Course with Coaching

To help reverse the worrying trend of burnout among health care professionals, IHI developed the Creating Workforce Joy and Well-Being, a 12-week online course full of new thinking, resources, strategies, frameworks, and solutions that will help workforces truly thrive.
IHI Forum 2023
December 10–13, 2023 | Orlando, FL, USA

The IHI Forum is a four-day conference that has been the home of quality improvement (QI) in health care for more than 30 years. Attend this year's conference in Orlando, FL, USA.

How Can We Define “Quality” in Health Care?

Donald Berwick, MD, MPP, Former President and CEO, Institute for Healthcare Improvement

Learning Objectives: At the end of this activity, you will be able to:

List the six dimensions of health care quality listed in a 2001 Institute of Medicine report Crossing the Quality Chasm.

Description: In this video, IHI’s Former CEO Don Berwick describes a 2001 report by the Institute of Medicine, Crossing the Quality Chasm, that laid the foundation for health care reform in the United States and spread around the world.

Unable to view this video? Read the transcript.

Discussion Questions:

Don Berwick describes six dimensions of quality in health care: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Have you ever encountered a failure in any of these areas as a patient or as a clinician? Describe the experience and how you would have liked it to be different.
In your hospital, clinic, or town, which of the six dimensions of quality presents the greatest challenge? In which area, if any, does your hospital, clinic, or town excel? What experiences have you had to support your views?

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by Giulia Ferrari 2/19/2020 12:22:51 PM In our clinic, we are assigned various roles so that we can focus on the tasks at hand. This has allowed us to be more patient-centered with the animal we are dealing with and has also allowed us to be more efficient as a team. When I was assigned fo surgery prep, I was allowed to excel at my position because I focused all my attention on the animal I was prepping so that I could make sure their vitals looked okay and that they were receiving the best care that they could. Safety is definitely one of the biggest challenges we face in the clinic because you never know what animal will walk through the door. Beyond that, an animal might initially seem friendly but proceed to show hostile behaviors as the day progresses. In these situations, you must read the body language of the animal so that no one is injured.

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by Giulia Ferrari 2/19/2020 12:18:52 PM I do not intern in a human healthcare environment, but watching this video made me realize that there are a lot of dimensions that overlap in terms of maintaining quality of healthcare for animals. In the Spay/Neuter clinic I intern at, the high volume operations that occur everyday pose several opportunities for mistakes and potential dangers. These dangers could arise from being careless or even not taking into consideration the behaviors of the animal you are dealing with. Therefore, it is absolutely necessary to be effective and efficient when dealing with an animal that might be hostile in order to protect yourself and the one around you. Furthermore, the timeliness is important when trying to make sure that all the animals are serviced and recovered properly. There have been situations when stress might have gotten in the way of maintaining these dimensions, and in these situations, you must remain honest so that the problem can be cleared up as soon as possible.

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by Will Schupp 2/3/2020 12:41:18 PM any healthcare setting

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by Will Schupp 2/3/2020 12:38:22 PM How do we curb current practices in our field to where we don’t allow chronic illness or other adverse health circumstances be disproportionately concentrated in people that are already in an unfavorable social position? Some food for thought. Then, one thing in particular that I noticed that the hospital I worked at does an absolutely excellent job at is patient-centeredness. Not just treating the patient with respect, but going above and beyond and really listening to the patients and their concerns. We may know the science, the medicine, but they (the patients) know their bodies. We have got to listen to them; make them a part of their own treatment. This cannot be overstated. My hospital, and, contrary to my first story most of the nurses, did a fantastic job really and genuinely caring for patients and letting them know that they and their insights into their own bodies are critical to the way we treat them and interact with them. This is crucial and mustn’t be taken lightly in a

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by Will Schupp 2/3/2020 12:37:22 PM 2) Okay. So for me, I live in Memphis, Tennessee where 65% of the town is African American and over a third of these individuals live below the poverty line (third of African Americans): a precursor for poorer, more dilapidated health and healthcare outcomes. I’m not going to sit here and type out what the social pathway, if you will, is for how low socioeconomic status can be transduced into poor health and healthcare related outcomes; just know that this, in fact, is the case. Now, the hospital I worked at in 2019 saw a lot of these people in particular where these individuals were of a particular racial or ethnic minority and were either uninsured, poor, or both, and, it is no coincidence that these people were far more likely than others to have some sort of chronic illness (or five…). So equity. Equity in healthcare is important. (to be continued)

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by Will Schupp 2/3/2020 12:35:51 PM The point is this lady was, in a profound way, blatantly ignoring her responsibilities as a nurse and was bringing about danger to the patient. This is unacceptable, and, in terms of relevance to Dr. Berwick’s points, this individual was breaching what is simply not okay when it pertains to just about every dimension of quality clinicians should regularly exhibit in practice: especially safety, which is beyond fundamental in this kind of a field. Now I don’t know what may have been going on in this individual's life (the nurse) that may have adversely affected her that day and led her to this kind of negligence, but I think an underlying theme here is certainly the importance of, not only safety of the patients, but also mental well-being and okayness, if you will, of the provider so that they can ensure that all of the principles are being met.

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by Will Schupp 2/3/2020 12:35:17 PM 1) This past fall I worked at an urban hospital in Memphis and definitely saw some blatant violations of these standards. Of these, one stands out in particular that I remember where a nurse on one of the more overcrowded wings of the hospital absolutely neglected her responsibilities to the patient in terms of safety in particular; long story short, a patient was screaming in pain for about 30 minutes and every time I would go to the nurse and tell her that her patient needed her immediately, she would either ignore me or say “she’s fine; just ignore her”. Now, obviously this nurse is the one that is caring for this patient, knows the patient and the condition of the patient better than I do, but the negligence of this individual was just absolutely and unbelievably disturbing. I, later, immediately reported her to the unit coordinator, leader of the floor, as well as the chief medical officer of this particular hospital. (to be continued)

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by Sandy Bradley 10/4/2017 4:44:50 PM We have introduced patient centered care in our hospital which has been vital in patient's being involved in their own care!

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by Karthik Iyer 4/4/2017 5:21:10 AM 1. Failure of patient-centeredness and efficiency primarily. There is a lack of involving the patients in the decision making process or explaining consents for surgical procedures adequately. Busy OPDs to ward rounds mismanaged by poor scheduling ends up hurting patients as they don't get enough face time with the doctors. Also, the workforce seems lethargic and due lack of incentives or a structure of accountability, the efficiency of getting things done is lacking. In an OT setting this is seen in lack of implementation of the surgical safety checklist and proper disposal of biomedical waste in the correct bins. 2. Patient-centeredness poses the greatest challenge. Education, research, getting large number of surgeries done often takes more priority over patient care and human aspect of medical care. Given the ingrained behavior of not giving primary importance to the patient, this poses the greatest challenge. 2.

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by Solomon Negash 2/19/2017 1:12:23 AM safety, effectiveness, patient centerless, avoid delays, efficiency, and equity are the 6 dimension of health where we can measure the quality.

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Audio and Video

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How Can We Define “Quality” in Health Care?

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