8.1 Quality Management

Attention to quality management in health care can bring a more rigorous and systematic approach to addressing documented deficiencies and cost savings. “Quality in public health is the degree to which policies, programs, services, and research for the population increase desired health outcomes and conditions in which the population can be healthy” [12]. By applying scientific standards and monitoring adverse occurrences, corrective actions can be put in place and monitored to determine effectiveness.
In examining frameworks for implementation of bio-vigilance systems, including the use of such systems for quality improvement, one must consider what types of events are captured. For instance, in order to capture rare events that are of significant singular importance for patient safety, a sentinel system should be 1) extremely sensitive, perhaps at the expense of specificity, 2) operated in real time in order to allow immediate registry of events, and 3) configured so that communication about the event allows critical response actions to take place.
An effective bio-vigilance program should be operationally capable of providing the core tools, infrastructure, and logistics necessary to support timely communication of critical information to the right people in order to make essential real-time interventions to avert clinical catastrophe and protect public health. Reporting must be safe. Individuals who report reactions or events must not be punished or suffer other ill effects from reporting. Otherwise, the fear of reprisal will limit the reporting and inadequate or false information may result in inappropriate or inadequate responses.
On the other hand, surveillance of more common events of interest may be more comprehensive. Capture of more common events also may allow benchmarking through comparison of event rates among facilities, which are most helpful if they are adjusted for factors that are not the focus of comparison. Such risk-adjusted rates allow valid comparisons and analysis, so that a quality program can be implemented and continuously evaluated, before, during, or after an intervention takes place.
Errors and accidents that result in adverse events are often blamed on personnel resulting in either retraining or dismissal. It has long been recognized that the majority of cases are due to a poor process rather than the fault of staff. When such events occur, the most efficient way of addressing them is through investigation and root cause analysis.