20 June 2024
Децентралізація
Development of a medical care quality system in municipalities
Development of a medical care quality system in municipalities

Medical care in Ukraine cannot be called the best. In this material, our experts speak frankly about the non-recognition of medical errors and the risks of treatment. If the municipality wants to seriously improve the quality of its health services, how to properly evaluate this quality and what are the important stages on the way to its improvement?


Patient safety is one of the most serious concerns in any healthcare system. To put it in perspective, the chance of a person being injured while travelling by plane is 1 in a million, while the chance of a patient being injured while receiving medical care is 1 in 300. Statistically, even high-risk industries, such as the aerospace industry or nuclear energy, have a much better safety record than the healthcare sector.

In the US, medical errors are the 5th leading cause of death. At the same time, there were none at all recorded in Ukraine for 2020. Obviously, this does not mean that Ukraine has a perfect healthcare system. The reason there are no statistical records of medical errors in Ukraine is the lack of a system of accounting and recording these errors. The main factors contributing to this include criminal liability for medical errors (in many first-world countries, medical errors are decriminalised) and a lack of effective systems for improving the quality of medical care, which would prevent medical errors or enable their detection.

The main goal of the healthcare system is the timely provision of high-quality medical resources to all those who need them. That is, ensuring a good quality of life, curing diseases when possible, extending life expectancy, etc. A variety of healthcare quality indicators are often used to try to assess the quality of care (QC), including estimates of increases or decreases in disease rates, reductions in the number of risk factors that people experience after preventive treatment, surveys of health status or health indicators for the population groups that have access to certain types of care. Note that according to the WHO definition, the QC consists of seven parameters:

  1. Efficiency: avoiding excessive and incorrect care, the fastest and most optimal achievement of the expected result.
  2. Safety: avoiding harm to patients from the care that is intended to help them.
  3. Patient-centred approach: providing care that is sensitive to the patient’s needs.
  4. Timeliness: reducing waiting times and harmful delays for patients.
  5. Financial efficiency: avoiding wasteful consumption of materials, medicines, use of equipment and other resources.
  6. Fairness: provision of care that does not depend on the patient’s personal characteristics or financial status.
  7. Integrated care: focus on persons with multiple health problems that involves comprehensive provision of services in the municipality.

Quality of medical care can be assessed at two different levels: at the individual patient level and at the population level.

At the individual patient — or micro-level, QC assessment focuses on health care services at the point of delivery, such as an outpatient primary care clinic or a hospital. In order to improve the quality of medical services in healthcare facilities, two directions should be developed:

  • Prevention of quality defects;
  • Monitoring to identify existing defects and their elimination.

Regarding the first direction, the most common methods include standardisation of medical care (e.g. implementation of patient treatment routes, standards of communication or behaviour, etc.) and staff training, as well as risk management. These measures are aimed at preventing errors during the provision of care. At the same time, the direction of monitoring and detection of defects in the quality of care primarily involves a set of measures that helps to identify problems and crystallise their causes. For example, evaluating the expedience of prescribing antibiotics in the surgical department, the expediency of conducting an x-ray examination of the chest organs by a family doctor, the quality of breast cancer screening at the first aid practice level, handling patients’ complaints, etc. Identified problems should be comprehensively analysed in order to find out their root cause, and measures should be taken to eliminate the root cause in the future based on the results of such an analysis.

At the population — or macro-level, assessing the QC involves working with an array of data to identify global health problems in the municipality. This segment of work falls within public health and may include indicators such as life expectancy, infant mortality rate, incidence and prevalence of certain health conditions, advanced forms of cancer, etc. An important challenge for most municipalities is the ability to conduct such a systematic analysis of a large array of data, determine key goals for analysis and make management decisions based on its results. For instance, if a large number of breast cancer cases are detected at stage 4, it may indicate ineffective screening in the target group in a specific municipality. Analysis of the causes of ineffective screening leads to the conclusion that the mammogram method is available, but primary care physicians overlook this examination. Based on this, a motivation system should be developed to include this examination in the target group among where key performance indicators (KPIs).

Furthermore, the availability of reliable data in digital format is the key and most important factor for building a medical care quality system. According to most experts, data collected and stored digitally are highly reliable, easy to process and analyse and facilitate the process of management decision-making. Therefore, digitisation of medical data is an additional healthcare priority at the municipal level.

Summing up, it should be noted that the creation of a medical care quality system is a large-scale task that would take a large amount of knowledge, skills and implemented measures that are necessary for its development. And while people are prone to making mistakes, as evidenced by the ancient Latin phrase, Errare humanum est, understanding medical errors in the work of healthcare facilities, as well as the methods of handling these errors, is the first step to improving the healthcare system of your municipality.

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