Measuring How Successful a Healthcare System Is

• US - Case report cards, error reporting mechanisms
  • Litigation ← financial compensation for patients
    • Doctors are not inclined to be completely transparent
    • If the harmfulness of litigation increased, doctors may play more "safely", rathe rthan in the patients best interests
    • Problems with the approach
    • Better access to materials did not help reduce maternal deaths in developing countries, rather it concluded quality was most important in maternal and many other diseases. But, these places lack systems because the are expensive to keep track off
      • Includes data points to collect to be successful
    • The mean time to clase a malpractice clain is 20 months
    • Injury claims to indicate quality of care: Summary - they can be used but should be accompanied with other indicators
    • How to adress the quality of care
• China - Started to shift to more private health care despite public health care still existing
  • Litigation Data ← Majority of these (89%) were for minor injuries or death (2010 - 2015)
    • 80% of cases came from internal medicine, general surgery, othopedics or gynaecology
    • Causes: Lack of Consent (25%), Misdiagnosis (21%), Delay in Treatment (21%), Forgery of Medical Records (18%P)
• Low - Middle Income Countries → Lack systems to measure quality of health care

1. Outcomes - Health status of patients after they recieved care
2. Process - Procedures involved in diagnosis and treatment
3. Structure - The human and material resources available and the infrastructure

Staffing In Relation To Hospital Perofrmance

• Nurses who had a higher than average patient ratio (usually 1:5) experienced significant burn out which led to 11% quitting
• For every additional patient on a nurse's workload, the chance of mortality increased by 7%