[How to improve clinical competence]

Abstract

Every day there are many patients that suffer or undergo more or less serious damage to their health because of the poor quality of healthcare they receive. Most of these injuries could be avoided by improving the professional quality of healthcare. This presentation outlines an ideal pathway by providing methodological indications and practical tools to clinicians and healthcare workers who wish to increase their skills in planning, supporting and evaluating initiatives of professional quality improvement in their organizations. In particular, the article indicates how clinical competence can be expressed, measured, evaluated and improved. To this end we introduce some basic concepts relative to efficacy (is what I do for my patients useful?), appropriateness (am I doing it to the right persons?) and effectiveness (does the treatment, when transferred to a local operating context, improve the health of the patients receiving it?). The article gives some suggestions to measure quality through process indicators (what has been done to the patients during the process of caring) and outcome indicators (the benefits obtained by the patients from the treatments received), highlighting both advantages and limitations. We then introduce four increasingly complex models for evaluating health interventions: descriptive evaluation, process evaluation, outcome evaluation and experimental designs. Finally, we describe Shewhart's cycle of continuous improvement, which is a useful tool for implementing, directing and spreading continuous quality improvement into an healthcare organisation.