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Chapter 5

At the end of the chapter, the reader will be able to:

1. Define health care quality.

2. Compare quality by inspection and quality assurance.

3. Compare various quality improvement techniques.

4. Define a framework for improving quality.

In its landmark reported titled Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) stated that “health care has safety and quality problems because it relies on outmoded systems of work. Poor designs set the workforce up to fail, regardless of how hard they try.”1 Let us take a closer look at these outmoded systems of work.

Doctors and pharmacists communicate primarily through a handwritten piece of paper called the prescription. On that prescription, instead of words are abbreviations in the long-dead Latin language. Barriers between doctors and pharmacists make it virtually impossible to immediately clarify those pieces of paper. The prescription does not have the diagnosis, so the pharmacist cannot assess whether the right drug, form, and dosing are appropriate for the patient. Often the names of the drugs look alike and sound alike. Very different drugs may be packaged in very similar containers thatÂ are stored right next to each other on pharmacy shelves. A pharmacist shortage created a new person called the pharmacy technician who has been given the responsibilities that a few years ago only a pharmacist could legally complete. In addition, there are no clear standards for educating, training, or credentialing technicians, so the pharmacist never knows whether the technician has baseline knowledge sufficient to assist the pharmacist. Computer systems provide frequent alerts but no clear guidelines on what to do when an alert pops up. Patients expect that the best pharmacies are the fastest and the cheapest. Patient counseling and confidentiality is required, but the pharmacy is not designed to accommodate confidential counseling. Intelligent, conscientious but human people make mistakes because they are stressed, tired, ill, or worried about personal problems that distract them. Finally, administrators, patients, and the public act surprised when pharmacists make mistakes and punish them. (This material is adapted from content developed by David Brushwood, R.Ph., J.D., professor of Pharmacy Health Care Administration, University of Florida from Ref.2) Punishing the pharmacist does not correct the system.

There should be no surprise that the system just described produces medication errors in any health care system. There is abundant evidence of the negative impact of quality on the U.S. medication-use system. Here are a few examples:

• Research suggests that for every $1.00 spent on a prescription, another$1.33 will be spent on a drug-related illness and complications.3
• Medical errors cost $3.5 billion each year. This figure does not include lost wages, compensation, or productivity, and was calculated with 2006 dollars (IOM, 2006). • Each year 1.5 million Americans experience a medical error (IOM, 2006). • Medical errors cost Medicare$887 million each year (IOM, 2006).
• Medical errors can cost as ...

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