Care quality

The term care quality tries to subject the performance of a service to an objective and a subjective standard at the same time. The elderly and nursing is an important service in healthcare . In a market economy system, it is subject to similar personal and economic influences as many other products or services. The term “quality” always refers to the quality or nature of a product or service in relation to its suitability for certain purposes (according to EN ISO 8402). Objectively, if it is “measured” with verifiable uniform descriptions - subjective, if it is “measured” with personal evaluations.

In nursing, the special quality of a service is primarily perceived and assessed by the patient or home residents. The professional quality of care but also the satisfaction and quality of life of those in need of care must be perceived as the focus of the initially unclear term. The relatives, the specialists (nurses), the doctors and other therapists involved, the operational management or the provider of a facility and the contractual partners health and long-term care insurance companies have certain expectations of the quality of the contractually agreed and provided services in the home or hospital .

Different definitions

In the last few decades there have been various approaches to defining the term quality of care :

1933 - Lee + Jones: Highly qualified nursing is nursing that applies all relevant knowledge and techniques that are available to nursing.

approx. 1965 - Four quality levels of the SRK

The “ Guide of the Swiss Red Cross Management School ” was the first specific definition of care quality in German-speaking countries. She named four levels:

Optimal

Well

Sufficient

Inadequate

When it was adopted in the FRG, however, the little word “sufficient” was not taken as a school grade, but interpreted by health policy as an already sufficient form of service provision. It was "overlooked" that care is then already in the gray area of "dangerous care".

1966 - A. Donabedian (initially independent of the nursing profession): Quality is the "degree of correspondence between the goals of the health care system and the care actually provided" (so still very abstract)

its subdivision of the overall quality into

Structural features (existing framework conditions, equipment, regulations to be observed)

Process characteristics (how care is provided, including intermediate controls)

Result characteristics (clear criteria required in each case, outcome research)

According to this, the Medical Service of the Health Insurance (MDK) also proceeds with its exams.

1978 - John Williamson: Quality is the extent of success that - under optimal conditions and reasonable costs - can actually be achieved.

Williamson adds the element of expediency to Donabedian's evaluative realm.

1981 - NF Exchaquet

Subdivision of care quality into

dangerous care

Routine care

adequate care

optimal design

1984 - Hilde Steppe: Care quality is the individual share of nursing care; So how is the patient treated, advised, informed, cared for.

Accordingly, the quality of care is not a static value, but always relates to the needs of the patient, the objectives of the provider and the possibilities given to care.

1994 - DIN standards , EN ISO 8402: Quality is the totality of properties and characteristics of a product or service that relate to its suitability for fulfilling specified or required requirements (European quality management standard in the 2005 version)

2001, 2004 - Reinhard Lay: "Care quality (in direct care) indicates the degree to which care goals are achieved, which relate to the promotion or maintenance of independence and well-being of the clients and which are aimed for with responsible interpersonal interaction and reasonable use of resources." (Lay 2001 : 20; 2004: 155)

The Care Quality Assurance Act

The Law on the Quality Assurance and to strengthen consumer protection in nursing ( Care Quality Assurance Act - PQsG) from September 9, 2001 completed the Eleventh Book of the Social Code - Social care insurance (SGB XI).

Since the introduction of long-term care insurance as part of social security in Germany in 1995, the quality of care (provision of services by professional carers) has repeatedly been brought into public awareness. In particular, some care scandals and the unsatisfactory results of quality checks by the home supervision and the medical service of the health insurance have pushed the political discussion about measures to improve the quality of care further. The Care Quality Assurance Act (PQsG) finally came into force on January 1, 2002. It aims to strengthen consumer rights in the field of elderly care . The provisions on quality assurance expanded by the Care Quality Assurance Act have been summarized in a newly inserted Chapter 11 of Book Eleventh Social Security Code (SGB XI). They are to be understood and read in connection with the Home Law .

Quality reports from hospitals

Quality reports from hospitals in accordance with Section 135 ff. Of Book Five of the Social Security Code are currently unsuitable for direct assessment of the quality of care, as the report does not take care quality into account as an individual criterion. It may be possible to indirectly deduce the quality of care if, in addition, z. B. Complication rates are published.

Quality management

According to ISO, quality management replaces the previous generic term quality assurance . It encompasses all aspects within and below the level of corporate management that are related to the fundamental attitude formulated by the top management level as well as the intentions, objectives and measures with regard to the achievement and improvement of quality. Here, aspects of economic efficiency, legislation and the environment, as well as the wishes and requirements of the customers, must be taken into account. The company management bears the non-delegable responsibility for quality management and must also actively ensure consistent implementation at all hierarchical levels.

An important step towards more quality in care was the discussion about the standardization of care measures , which took a large part in the 80s / 90s. There was the apparent opposition of “traditionalists” who defended individual care from a mixture of specialist knowledge and heart against “technocrats” who were accused of being rude about regulation or excessive statistical collections. In the meantime, the importance of care standards is generally recognized and in Germany it is already partly about the development of expert standards, i.e. standards at the federal level. These expert standards are now also binding according to Section 113a of SGB XI.

Another aspect is individual care planning , which, however, has to comply with standardized minimum standards. In-house care planning and care or organizational standards have the value of service instructions. The nursing management must be able to rely on the uniform handling of such guidelines / guidelines.

Implementation aspects are addressed with internal or external quality assurance :

Internal quality assurance: Assurance of the quality and definition of the criteria by the professionals within an institution themselves.; The tasks of a quality officer are the introduction, implementation and further development of an institution's internal quality management. Goals are set with the approval of the facility management. The quality officer fulfills the tasks according to the objective in close cooperation with the department heads and their employees, including the quality management of the provider of the care facility.; Systematic evaluation of the care plans of the entire facility; Quality circles are internal working groups that activate the great potential of knowledge, inventiveness, experience and willingness to take responsibility of employees. They are primarily aimed at improving work processes that affect several departments. This not only improves the quality of the products or services, but also the performance potential of employees and possibly the working atmosphere.

External quality assurance: Determination of the quality criteria and their review by persons not belonging to the institution or external institutions, especially the home supervision and the MDK, but also by regional quality working groups of several institutions (quality conference); u. a. also the monitoring of the quality of care in terms of benchmarking

literature

Myriam Barth: Quality development and assurance in geriatric care. 2nd Edition. Urban & Fischer, Elsevier, Munich 2002, ISBN 3-437-47220-8

Besselmann Klaus, Sowinski Christine, u. a. ( KDA - Hrsg.): Quality manual living in the home - Paths to a self-determined and independent life in the home - A manual for internal quality development in the AEDL areas . Cologne, Board of Trustees for German Old Age Aid 1997.

Alexandra Caster: Quality in inpatient care for the elderly. The importance of certification . Publishing house Dr. Kovac, Hamburg 2004, ISBN 3-8300-1577-1 , 249 S. Review Georg Vogel from December 27, 2005 In: socialnet.de

Avedis Donabedian: Evaluating the Quality of Medical Care . In: The Milbank Memorial Fund Quarterly. Vol. XLIV, no. 3, Part. 2, 1966, pp. 166-206.

Avedis Donabedian: The definition of quality and approaches to its assessment. Explorations in quality assessment and monitoring. Health Administration, Ann Arbor MI 1980

NF Exchaquet, LA Paillard: The Nursing Process - A Challenge for the Profession. Report of the National Study on the Nursing Process . Publisher of the Swiss Professional Association for Nurses and Nurses, Bern 1986.

Alfred J. Gebert, Hans-Ulrich Kneubühler: Quality assessment and evaluation of quality assurance in nursing homes. A plea for learning together. 2nd Edition. Verlag Hans Huber, Bern 2003, ISBN 3-456-83934-0 , 507 pp.

Sabine Jäck, Silke Proschmann: Quality testing and evaluation of outpatient care services . Kohlhammer Verlag, Stuttgart 2004, ISBN 3-17-018086-X , 176 S. In: socialnet Reviews under review Christoph Langewitz from March 29, 2005 at socialnet.de

Andrea Kerres, Bernd Seeberger: Complete textbook care management. Springer, Berlin 2005, ISBN 3-540-23736-4 , 484 pp.

Bernd Kiefer, Bettina Rudert: Quality management. Easily and effectively with mind maps. Vincentz Network, Hannover 2006, ISBN 3-87870-646-4

Dieter Knon, Horst A. Gross, Werner Lobinger: Quality management in care. Hanser Wirtschaft, 2005, ISBN 3-446-22989-2

Uwe Brucker, Gerdi Ziegler: Policy statement: maintenance process and documentation. Recommendations for action for professionalization and quality assurance in nursing. Medical service of the central associations of health insurance companies (MDS), Essen 2005, 72 p. Download possible from MDS (approx. 800 kB, PDF).

Christine Sowinski, Juliane Falk u. a .: Theory-guided work in training and practice. A component for quality assurance in elderly care. 1995, 2nd A. 1997. 287 pages. ISBN 3-932882-02-4

Barbara E. Wagemann: Quality manuals according to DIN EN ISO 9001 for inpatient care facilities for the elderly. Manuals through to certification . 2nd Edition. Schlütersche Verlagsgesellschaft, Hanover 2005, ISBN 3-89993-145-9 . Review by Sven Lind in: socialnet.de

Ursula Weibler, Gundo Zieres (ed.): Quality in geriatric care - inventory, information, advice . Iatros Verlag, 2005, ISBN 3-937439-92-7 , 268 pp. (From the point of view of the medical service of the health insurance Rh.-Palatinate)

Reinhard Lay: Ethics and quality of care. In: Manfred Bergener, Hellmuth Fischer, Marita Heimann, Günter Thiele (eds.): Management Handbook for Elderly Facilities (MHA) . R. v. Decker's Verlag, Heidelberg, 17th edition, May 2001, 925, pp. 1-23

Reinhard Lay: Ethics in Nursing. A textbook for basic, advanced and advanced training. Schlütersche Verlagsgesellschaft, second, updated edition, Hanover 2012, ISBN 9783899932713 , review by Prof. Dr. Katja Makowsky in: socialnet.de

Web links

Wolfram Fischer: Does performance recording have anything to do with the quality of care?

Note : This article is based in part on a GFDL -licensed text that was taken from the PflegeWiki . A list of the original authors can be found on the version page of the corresponding article n3.