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FOTO Rehab Outcomes Blog

How Do You Define Quality?

From a big picture perspective, the rehabilitation industry hasn't defined quality. The industry has outside stakeholders at the helm measuring "quality" based on codes or based on claims data. I can appreciate this definition from the Chartered Quality Institute. "Ultimately quality is an outcome."
Quality is an outcome... and an outcome is the result from a process.


If we think about W. Edwards Deming (since he is the "father of quality") and his thoughts on quality, you will see this equation for quality.


Deming believed that if companies focused on quality, their costs would decrease. He also believed that if companies focused on costs, quality suffered. The costs in this equation are the costs associated with delivering a defined level of quality (both your costs and the cost to the patient).

In rehabilitation, work efforts are a combined effort, your patient's effort and your effort. This includes the processes associated with the work effort. Total costs would also include time and money. From this equation, if high results can happen with minimal effort from both you and your patient in a short amount of time, quality increases. 

As you can see, for rehabilitation professionals, quality doesn't reside in a vacuum. Quality results are dependent upon a patient's involvement in the equation. Let's say a patient had an intense amount of work effort, had a lengthy drive time, had a high amount of visits and had a high amount to pay for a high outcome. How would that scenario compare to a different patient who had a low amount of work effort, medium amount of drive time, low number of visits and a low amount to pay for the same high outcome? As you can see, there are patient-related variables that would contribute to quality. The second scenario would be a higher level of quality based on Deming's quality equation.

The clinician also has factors associated with providing care that contribute to quality. How much time does the patient spend waiting? How much time does the clinician spend documenting? Are patients included when designing treatment plans? Does the clinician take into consideration a patient's goals? Does a clinician use practice based evidence? How effective and efficient are the final results?

Quality is a complex topic which has been difficult to define because of the varying perspectives. Rehabilitation professionals are not able to control every variable involved in providing high quality care. What rehabilitation professionals can do: review processes, streamline processes, measure outcomes and manage outcomes. The manufacturing industry is held accountable for its products via specifications. Rehabilitation professionals can also define the level of quality they will meet. Because the quality equation also includes the patient, when defining a level of quality to provide, the specifications determining conformity would need to take into consideration uncontrollable variables (i.e. patients).

FOTO can help with some aspects of quality. FOTO can help you measure and manage your outcomes. FOTO also has a role in quality assurance. If you are in need of a system to help you understand your level of quality delivered from an effective and efficient perspective, please talk to Judy Holder. FOTO can definitely be a solution for you.

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Until next time,