Quality management in healthcare
In the context of medical treatment, quality of care can be defined as realising achievable benefits whilst eliminating unnecessary effort and avoidable risks.
Quality healthcare:
- Achievable benefits > achieved
- Unnecessary actions > avoided
- Avoidable risks > avoided
It is generally accepted that patients' subjective judgement must determine whether benefits are achieved and pain therapy is successful.
Clinical pathways, which guide the clinician via a series of alternatives, indicate the most promising treatment strategy for the individual patient and avoid unnecessary effort. Good clinical practice is a decision-orientated process with individual steps to ensure that treatment progresses and to anticipate unfavourable developments.
Continuous search for improvement
Quality management may also be defined as “the continuous search for improvement by finding and solving problems”. This should be a principle of professional leadership in healthcare, based on a continuous evaluation of efficiency, effectiveness and outcome with respect to patients' medical and psychosocial condition and requirements. The evaluation should focus on process and care, rather than structure and disease.
To develop their skills it is essential for clinicians to structure information and to incorporate defined outcome indicators in a rapid evaluation process. This should be based on appropriate electronic documentation and should focus on decisions and problem-solving.
Evidence-based medicine (EBM)
Evidence-based medicine (EBM) is the systematic review, appraisal and use of clinical research findings to aid the delivery of optimum clinical care. EBM guidelines, which require considerable effort and commitment to develop, are designed to help practitioners and patients decide on the appropriate healthcare for specific clinical conditions and situations.
In addition, scientists, politicians and healthcare purchasers take into account the strength of scientific evidence regarding clinical practice and cost effectiveness when allocating resources.
But the EBM application may be difficult in practice. For example, where multiple pathologies, clinical management are highly variable, or a patient's condition changes over time, EBM guidelines may be compromised or not appropriate.
P.A.I.N. Methodology
The P.A.I.N. Initiative has modified well-established total quality management (TQM) techniques to create a new holistic methodology for improving pain management.
The “educated guess” approach
To apply EBM in “real life”, the P.A.I.N. Initiative encourages the use of “educated guesses”, which incorporates individual clinical expertise and the best available scientific evidence. Various factors are involved in the new approach. They are integrated to produce the “educated guess” or clinical decision. The difference between the “educated guess” approach and EBM is the application of the decision in daily practice. “Educated guess” relates to “reality-based” medicine, using evidence wherever it is applicable and practical.
The impact of all clinical decisions on standardised outcome criteria is evaluated. Continuous Plan > Do > Check > Act cycles (Figure 2) identify best practice and improve practical pain management. Higher levels of efficiency, relevance and the constant feedback lead to excellence in healthcare quality management.
Doctors using “educated guesses” produce their own success and improve the quality of their care. The intention is not to complete EBM, but to make practice more efficient and cost-effective and to create a learning environment in clinical practice.
