The survey of QA in hospitals found that:
- An estimated 70% of hospitals supplying 90% of acute beds and accounting for 90% of annual separations had programs reviewing the quality of care. There was little difference between the public sector overall and the private sector. The proportion of hospitals with QA in the Slates varied widely but because there was a strong association between hospital size and QA activity, there was greater consistency in terms of bed numbers. However, some States have further to go than others in implementing QA programs in their hospitals.
- Results relating to the range of activities raise questions about the adequacy of these programs. On the basis of this evidence, in both sectors, only about 25% of hospitals, supplying about 50% of beds, scrutinise the quality of patient care on sufficient fronts to be considered effective. This applied even in some hospitals with a teach,ing function.
- ACHS accreditation was one indicator of organisational commitment to quality assurance. It was associated with hospitals demonstrating QA activity, but many non-accredited hospitals also reported QA activities.
- 4. Direct funding for QA was rare. Implementation of QA was expected to be part of normal duties, even when the burden of organisation and documentation fell on a small number of people, often without computing facilities and integration into routine hospital information systems.
- The types of review being carried out in public and private hospitals rellected the priorities and roles of each sector. Notable disparities between hospitals were revealed across the States in reviews of medical records and clinical services, and patient satisfaction surveys.
- Two types of QA review were performed more frequently than others:
- utilisation review, probably indicating a response to pressure of cost restraint and reducing length of stay;
- reviews of clinical services, a finding apparently at odds with the reported reluctance of medical practitioners to review their performance. (This survey was unable to address this issue, but possible contributing factors have been suggested.)
- The processes involved in carrying out QA showed some important deficiencies. The results suggest:
- an inflexible approach to identifying problems and setting priorities;
- a need for external standards review to ensure that standards formulated 'in-house' reflect expert opinion; and
- limited dissemination of review findings and a need for encouragement and continuing education to accelerate development.
- The line of accountability for QA within hospitals varied considerably but two significant features could be identified:
- QA coordinators from a non-nursing background were more likely to be employed in hospitals with a wider range of QA than those with nurse training. This no doubt reflects, at least to some extent, the role limitations placed on nurse coordinators.
- Overall, CEOs taking responsibility for patient care were associated with larger hospitals, a high number of QA activities, and accreditation. The reverse was true when DONs took responsibility for patient care. To some extent this was an artifact of hospital roles.
- The most important factors that influenced the vigour of QA in hospitals were hospital size, accreditation, public/private sector, and State. These last two factors might be called 'the owner' of the hospital. Since hospital size and QA activity are largely interdependent and it is the owner that initiates participation in accreditation, the essential element of an active QA program is the owner. This is because the owner creates the organisational environment that facilitates and potentiates the pursuit of improvement in quality.