Assessing the quality of healthcare practice : a risk-based approach

Abstract

Background: This research article explores a novel framework for assessing the Quality of Healthcare based on principles of Clinical Risk Management, including the development of a theoretical construct for the quality of healthcare services based on stakeholder needs, and a conceptual model for managing risks at an institutional level. Methodology: The study consisted of a cross-sectional secondary assessment of healthcare service and system-level indicators, guided by a structured decision tree based on face, construct, content, and criterion validity. Established performance measures identified from international benchmarking and institutional quality improvement frameworks were classified and validated for assessment of clinical risks according to indicator type. Results: A total of 233 performance indicators were evaluated, of which 200 (86%) consisted of measures for assessing failures in clinical practice. According to the proposed framework, (30%) and (14%) of indicators met the criteria for assessing risks associated with clinical processes and organizational systems design respectively. Conclusion: More targeted use of indicators is required in order to achieve a greater degree of accuracy and actionability of performance assessment measures in healthcare practice. The proposed framework offers an applied method to enhance the specificity of quality indicators and direct efforts to improve systems design and decision-making capability.