Allen-Duck Angela, Robinson Jennifer C, Stewart Mary W
University of Mississippi Medical Center, Jackson, MS.
Professor of Nursing, University of Mississippi Medical Center, Jackson, MS.
Nurs Forum. 2017 Oct;52(4):377-386. doi: 10.1111/nuf.12207. Epub 2017 Apr 13.
Worsening quality indicators of health care shake public trust. Although safety and quality of care in hospitals can be improved, healthcare quality remains conceptually and operationally vague. Therefore, the aim of this analysis is to clarify the concept of healthcare quality. Walker and Avant's method of concept analysis, the most commonly used in nursing literature, provided the framework. We searched general and medical dictionaries, public domain websites, and 5 academic literature databases. Search terms included health care and quality, as well as healthcare and quality. Peer-reviewed articles and government publications published in English from 2004 to 2016 were included. Exclusion criteria were related concepts, discussions about the need for quality care, gray literature, and conference proceedings. Similar attributes were grouped into themes during analysis. Forty-two relevant articles were analyzed after excluding duplicates and those that did not meet eligibility. Following thematic analysis, 4 defining attributes were identified: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these attributes, the definition of healthcare quality is the assessment and provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of optimal or desired health. This analysis proposes a conceptualization of healthcare quality that defines its implied foundational components and has potential to improve the provision of quality care. Theoretical and practice implications presented promote a fuller, more consistent understanding of the components that are necessary to improve the provision of healthcare and steady public trust.
医疗保健质量指标的恶化动摇了公众的信任。尽管医院护理的安全性和质量可以得到提高，但医疗保健质量在概念和操作上仍然模糊不清。因此，本分析的目的是阐明医疗保健质量的概念。沃克和阿万特的概念分析方法是护理文献中最常用的方法，它提供了框架。我们搜索了通用词典和医学词典、公共领域网站以及5个学术文献数据库。搜索词包括医疗保健和质量，以及医疗和质量。纳入了2004年至2016年以英文发表的同行评审文章和政府出版物。排除标准包括相关概念、关于优质护理必要性的讨论、灰色文献和会议记录。在分析过程中，将相似的属性归为主题。在排除重复项和不符合资格的文章后，对42篇相关文章进行了分析。经过主题分析，确定了4个定义属性：(1)有效，(2)安全，(3)卓越文化，(4)期望结果。基于这些属性，医疗保健质量的定义是对有效和安全护理的评估与提供，体现在卓越文化中，从而实现最佳或期望的健康状态。本分析提出了医疗保健质量的概念化，界定了其隐含的基础组成部分，并有潜力改善优质护理的提供。所呈现的理论和实践意义促进了对改善医疗保健提供和稳定公众信任所需组成部分更全面、更一致的理解。
