While there is no general or universal definition for “quality care”, most authors agree on defining the term as high-standard medical, therapeutic and social care which is person-centred and tailored to individual needs and preferences. Quality care is more often than not a highly subjective concept, which is easily influenced by particular situations, contexts, environments and people. The NMC Code of professional standards of practice and behaviour for nurses and midwives links the concept of quality care to meeting the patients’ needs and expectations, respecting their rights and working within the standards outlined by the regulators. The Health and Care Professions Council (HCPC) Standards of conduct, performance and ethics (2016) do not actually mention “quality”; however, it is generally agreed that the overall description of professional conduct gives us in fact a very detailed account of what is meant by quality in health and care professions:
- Promote and protect the interests of service users and carers
- Seek and obtain informed consent before treatment
- Challenge discrimination
- Communicate appropriately and effectively
- Work within the limits of your knowledge and skills
- Respect confidentiality
- Manage risk
- Report concerns
- Be open when things go wrong
- Be trustworthy and honest
Moullin (2003) highlights the difficulties with regards to implementing a clear definition of quality care. The main problem lies not as much in the great number of definitions in current use, but rather in the fact that most of these definitions transmit different messages to care providers and health care managers as to what quality care really means. Moullin further goes to state that the multitude of definitions also signal a lack of unified vision for quality care between different agencies and organisations: “It would be a mistake to assume that the drive for quality is underpinned by common understandings of quality either within the NHS or between the NHS and other organisations. Definitions of quality vary profoundly between different groups of staff and between staff and patients.” (Moullin 2003: 7).
Mainz (2004) believes “our knowledge of quality of care is limited”, especially with reference to specific conditions and diseases. Stopper et al. (2011) draws on personalised care as the best equivalent to quality care, while Stadnyk et al. (2011) focus on multidisciplinary care that integrates process measures with outcomes that are important to the patient’s functional status and quality of life. Other authors, such as Coleman (2003), choose not to define quality of care at all, but rather to apply the concept to different situations and target populations.
The concept of quality care is highly subjective, as it means different things to different people; it is also circumstantial, as its meaning is prone to change with a change of circumstances to which the concept refers to or in which it is applied. What counted as high quality care for people with complex needs 15 years ago may only amount to an acceptable level of care today, as care quality standards and people’s perceptions have changed to accommodate increasing demands and expectations. In his efforts to define quality of care, Donabedian (2003) puts forward a schematic illustration of the components of quality in health care, believing any of the components and attributes listed in the figure below can “constitute a definition of quality” and “signify its magnitude” when considered separately or in various combinations (Donabedian 2003: 4-5).
Cite the references.
Reference the year.
By whom? References
This sentence is not very clear – it seems to cover two points, implementation and clear definition.
Do any of these relate to people with complex needs?