Comprehensive Care Vs Comprehensively Cared For

Sep 19
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With the second edition of the National Safety and Quality Health Service (NSQHS) Standards now in full swing, the Australian Commission on Safety and Quality in Health Care (the Commission) is primarily focused on protecting the public from harm and improving the quality of health service provision.

One of the biggest changes from the first edition to the second is the new Comprehensive Care Standard. Standard 5, the largest of all the eight standards, is about how leaders of a health service organisation establish and maintain systems and processes to support clinicians to deliver comprehensive care. The main driver for the introduction of the new Comprehensive Care Standard was to ensure that risks of harm to patients during an episode of care are prevented and managed.

In my professional opinion, having worked as a Registered Nurse here in Australia and New Zealand for more than a decade, I believe this is one of the greatest amendments to the national standards. In a previous role as a Director of Nursing for a private hospital in Brisbane, I played a key role in leading teams through accreditation against the first edition. I always felt like there was something missing from the ‘old’ NSQHS Standards and the opportunity for improvement has allowed for positive updates to occur. Now with a specific focus on the coordinated delivery of the total healthcare required or requested by a patient, I believe, this is a step in the right direction.

Although interrelated, ‘comprehensive care’ and ‘comprehensively cared for’ are distinctly different concepts, and as such, need to be approached differently. In my view, comprehensive care is from the perspective of the organisation and whether or not they have achieved the desired standard of care. Comprehensively cared for is the patient’s perspective and whether or not their desired standard of care has been met. The point I am trying to make is that although the focus on comprehensive care is a welcomed change to the national safety agenda, this concept is only as successful as the patient says their care is. The question still remains, will the introduction of this new standard result in patients being more comprehensively cared for and if so, how will health service organisations know they’ve improved?

The answer lies within what we capture, analyse and act on in terms of healthcare data. At a facility or hospital level, indicators are what is commonly referred to when we talk about healthcare data. Indicators can be described as three types—outcome, process or structural. In my experience outcome metrics or indicators are the most reliable when trying to assess the effectiveness of care delivery. A health outcome is a change in the health of an individual, or a group of people or population, which is wholly or partially attributable to an intervention or series of interventions.

When we refer to comprehensive care from the perspective of the organisation, we see three principal forms of health outcomes measurements being used: measures of physiological parameters, clinician-reported outcome measures, and health outcome-related performance indicators. When we refer to comprehensive care from the perspective of the patient and family, we see two principal forms of health outcome measurements being used: patient-reported experience measures (PREMS) and patient-reported outcome measures (PROMS).

What I am really interested in is how we can utilise PROMS alongside PREMS to better understand the patient perspective of the quality of care they are receiving. PROMs are gathered by undertaking questionnaires which patients complete. They ask for the patient’s assessment of how health services and interventions have affected their quality of life, daily functioning, symptom severity, and other dimensions of health which only patients can know. Using PREMS and PROMs together promises to fill a vital gap in our knowledge about outcomes and about whether healthcare is actually making a positive difference to our patient’s care.

At the upcoming Criterion Conferences’s ‘Implementing Comprehensive Care in Sydney, on Tuesday 15 October at 4.10pm, during my presentation I will be showcasing a new tool that QIP has developed, based on national and international research, called the Patient Reported Outcomes and Care Experiences (PROCEs) Survey. The PROCEs Survey can be used by health service organisations at different points of the patient’s care journey (pre, intra and post-admission) to achieve a much clearer understanding as to whether they are accomplishing the level standard of care patients expect.

I look forward to speaking with you on Tuesday 15 October otherwise please ‘link in’ or phone me via the details below.

Julian De Maria (RN, BN, MClinEd)
National Manager, Hospital and Day Procedure Service Accreditation
Quality Innovation Performance Limited (QIP)
P: 1300 888 32


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