Sheps in 1955 stated that the method of evaluating the quality of health care should be determined by the purpose of the evaluation. If the purpose of the evaluation is to issue licenses, certificates of practice, or to let patients know where to go, then the evaluation method should be able to distinguish between "good enough" and "not good enough". ". If the purpose of evaluating the quality of health care is to promote improvements in the quality of health care, the methodology chosen must not only be able to distinguish between "good" and "poor" in general, but must also be able to identify areas where the quality of health care should be improved.
In 1996, Avedis Donabdeian described a three-pronged approach to evaluating the quality of health care in terms of structure, process, and outcome [8]. "Structure": i.e., all the relatively stable (physical and organizational) characteristics of an institution that provides health care services; "process", i.e., what doctors and other health care workers do for patients and how skillfully they do it; and "outcome", i.e., all the relatively stable (physical and organizational) characteristics of an institution that provides health care services; "process", i.e., what doctors and other health care workers do for patients and how skillfully they do it;" Outcome" is the change in health status (for the better or for the worse) as a result of the evaluated health care service. He noted that the quality of health care could be measured by health care outcomes (e.g., recovery of function) and that these outcome indicators were highly reliable. However, he emphasized the limitations of using health care outcomes as indicators of health care quality. First, it is difficult to use existing outcome indicators (e.g., death) that can be used to identify conditions that are not fatal but that can affect the degree of healthiness in the provision of health care services; and second, there are many non-health-care factors that may affect health-care outcomes. Therefore, if reliable conclusions about the quality of health care are to be drawn, it is important to hold constant all factors other than health care factors that have a significant impact on health care outcomes; and thirdly, in some cases it is particularly important to consider the fact that some health care outcomes take a longer period of time (potentially several decades) to become apparent. In the third case, when the quality of health care needs to be evaluated, it is possible that the health care outcomes are not yet apparent. If a hospital's health care is likely to have a negative impact, we will certainly want to use other methods to identify quality problems in health care as early as possible.
Because of the practical problems of measuring health care quality in terms of health care outcomes, emphasis has been placed on measuring quality in the health care process. The greatest advantage of this approach to evaluating health care quality is that it is often more actionable, especially in the case of chronic disease, where "process" evaluation is faster than "outcome" evaluation. However, this "process" approach requires attention to the specificity and reliability of measurement and evaluation criteria. The basis of "process" evaluation as an evaluation of the quality of health care is that the indicators used as "process" measures must have a reliable and stable relationship with the "outcome" indicators. The third approach to evaluating the quality of health care is to measure the "structure" of health care, such as financing, facilities, hospital beds, equipment, and staffing. The assumption of this approach is that appropriate health care "structures" will lead to appropriate health care services. The advantage of this approach is that the information required is often specific and readily available, but its limitations are the linkage between "structure" and "process" and "structure" and "outcome". "A comparison of the three types of health care quality assessment is shown in the following table [10]. In view of Donabdedian's comparison of the three measures of health care quality and the characteristics of community hospitals (outpatient-oriented, geriatric-oriented, chronic disease prevention-oriented), it is appropriate to evaluate the quality of health care in community hospitals from the quality of the "process".
Schedule Comparison of three types of health care quality evaluation methods
Items Outcome evaluation Process evaluation Structural evaluation
Contents Net change in health outcomes due to medical services Evaluation of medical behavior of medical personnel by the standard of practice of medicine Organizational setup, fixed assets, medical and management procedures, organizational forms and other institutional characteristics
Evaluation of the validity of the high, medium and low.
Methodology Complexity Simplicity Simplicity
Cost High Medium Low
Sensitivity Strong Medium (same process, different outcomes) Weak (high inputs, low outputs)
Time Fixed Relatively Fixed Free
Evaluating the quality of health care in terms of consumer satisfaction. Wendy Leebov and Cail Scott point out that the competition of the future will be won by organizations that are internally coordinated and aligned, and the best way to achieve this is to focus the organization on the consumer. Forward-looking companies and health care organizations are shifting their focus from outdoing their competitors to satisfying their consumers. Consumers choose healthcare organizations based on quality, and it is the quality of service that is most influential in that choice. While consumers may not always know how to evaluate the quality of the health care provided, they do know how to evaluate the quality of the service they receive [11].
China's Ministry of Health, in order to implement the spirit of the "Central Committee, the State Council on health reform and development of the decision", the full implementation of the Central Propaganda Department of the top ten service industries to carry out "for the people to serve the new style of the industry," the deployment of the activities, the creation of a nationwide "patient-oriented, quality service 100 best hospitals. Patient-centered, high-quality service hundred hospitals" work. Although the creation of this hundred hospitals in the second or third-class hospitals, but the purpose of the activity - patient-centered, quality service is also applicable to community hospitals, "patient-centered, quality service", is to respect the patient, Convenience to patients [12], is to achieve the six aspects of quality service: good interpersonal communication skills (people skill), good amenities (amenities), good service systems and processes (systems and processes), good environment (environment), good clinical skills ( rechnical and clinical competence) and lower service cost (cost) [11]. In recent years, many scholars at home and abroad have conducted consumer (patient) satisfaction surveys.
Through the evaluation of the quality of medical services, the problems in the process of medical services are found, which is conducive to hospitals and health administrative departments to strengthen the management of the weak links, so that the quality and cost of community medical services can be accepted by the residents.