What are Quality and Quality Improvement?
The 2001 Institute of Medicine (IOM) publication Crossing the Quality Chasm: A New Health System for the 21st Century1 defines quality in health care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” It further explains “good quality means providing patients with appropriate services in a technically competent manner, with good communication, shared decision making, and cultural sensitivity.”
The IOM established 6 dimensions of quality: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equitability.
In essence, health care should avoid injuring patients, should provide services based on best practices, should be respectful of patients' needs, should reduce long waits and delays, should avoid wasting resources, and should not vary in available options because of patients' demographics.Quality improvement is a process that seeks to systematically, objectively, and continuously monitor, assess, and improve quality and the appropriateness of patient care provided on the basis of predetermined standards. Although leadership will direct the people responsible for monitoring activities, reviewing events, and providing recommendations for individual and team improvement, quality improvement should involve all care providers and parties in the sphere of the transport program.
How does a transport service track “quality?” Most transport teams monitor anything from operational factors such as delays in mobilization of the transport team to measures of patient outcome. Often, these measures are based on transport teams' histories, high-profile transport cases, lessons learned from morbidity and mortality conferences, patient outcomes, etc, or are borrowed from other areas of medicine (eg, neonatology, critical care, emergency medicine). Some track transport-specific measures suggested by professional organizations or legislative bodies, though at the present time, these are rare and typically not evidence-based. The Commission on Accreditation of Medical Transport Systems (CAMTS) is an accrediting body that aims to assist the transport community in providing a specific level of quality. Accreditation is a voluntary process in which an accrediting board of experts evaluates a program or institution against measurable standards and criteria—a formal transport service quality monitoring system is one of those criteria.