Healthcare services are imperative in everyday life because, to a greater extent, they determine the quality of lives we lead. As such, quality must be ensured. Like any other industry, medical malpractice is a quality problem in many health care sectors. However, with medical research and education advancement, the focus and attention on quality have made significant industry improvements. The purpose of this paper is to shed light on the historical context of quality of care. It seeks to analyze the history of medical malpractice, why regulatory agencies started monitoring quality, and their impact on the quality of care. Additionally, it will compare the current state of quality with the quality in the 1800s and how it has or has not improved since the 1800s.
Historical Review of Quality of Care
In the current era, quality is measured by the environment in which health care services, knowledge and resources, and simple improvements such as hand washing and sterile environments. It is different from how quality in the 1800s was assessed. According to Breslaw, early healthcare was not based on scientific methods today (2012). Mainly, people depended on midwives, home remedies, or local folk healers to identify and treat them. It means that disease diagnosis was inaccurate since most of them relied on observation. However, the current system uses technology and scientific methods to diagnose and treat illnesses. This poses a quality gap between the care services in the 1800s and now.
Regulatory agencies began monitoring quality in healthcare primarily due to two reasons. The first one is to reduce the costs of healthcare. Low-quality healthcare services resulted from high costs. For example, physicians with little knowledge on the field may describe wrong medication, resulting to further health complications, which may require more funds to treat. The second reason is to improve the quality of care by limiting healthcare practitioners from doing certain practices. For example, by licensing healthcare facilities, the agencies limit each facility with only trusted practices. Hence, to improve the quality and costs of healthcare services, regulatory agencies began to monitor the sector.
The history of medical malpractice dates back to a thousand years ago. According to a physician news writer, Anderson, since the 19th and 20th centuries, medical malpractice has been one the oldest legal writings in the world (2017). An example of one of the oldest and writing on medical malpractice is Hammurabi’s code consisting of 282 laws and dated back to 1794 BC (Anderson, 2017). The section mentions some of the medical mistakes and their repercussions. For example, one section states that doctors should be punished if they harm patients. Many of the malpractices in the past involved doctors treating patients wrongly due to insufficient medical training and education. However, much has been done to address such malpractice. For example, the American Medical Association was formed to help set medical training and education standards. This has led to many people acquiring professional training in medicine, reducing malpractice. Also, legislation has been put on the frontline to help prevent doctors from committing malpractices. Unfortunately, as a result of different legislation surrounding this area, defensive medicine has been on the rise (Reisch et al., 2015.
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Deemed status is the status that a health organization acquires after being accredited by the regulatory agencies (Hedrick & Gingerich, 2006). It depicts an organization that meets the health standards required, meets the expectations, and exceeds them. As a result, organizations such as Agency for Healthcare Research and Quality (AHRQ) are put in place. Its primary purpose is to research the healthcare systems by doing demonstration projects, evaluations, coming up with guidelines, and disseminating health care information. Its primary goals are to; make healthcare safer, improve the quality, make it more accessible, equitable, and affordable (AHRQ, 2021).
Another organization that improves quality is the Joint Commission. Its primary purpose is to regulate quality by accrediting healthcare organizations. The accreditation acts as a form of licensure given to organizations that comply with the set quality standards. Its major goals are to ensure medical services lead to zero harm and ensure they are safe and quality (About the Joint Commission, n.d.). AHRQ and the Joint Commission have impacted healthcare quality by continuously adding knowledge to improve the services through research and ensuring only organizations that meet the required quality standards operate.
Improving Quality of Care by Understanding History
History can help improve the quality of care. Understanding how the healthcare field has evolved sheds light on how the sector has evolved, what has worked and what has not, and what can be done to improve. For example, by understanding that medical malpractice started because of insufficient knowledge and training on the medical practice, more training and knowledge can be imparted to physicians to improve healthcare quality. Additionally, understanding that some legislations could lead to defensive medicine could help loosen them to help prevent such malpractice.
To sum up, healthcare quality is imperative and needs to be taken care of. While it was low in the 1800s, research by organizations such as AHRQ has helped improve through significant steps. Regulatory agencies have been at the forefront of ensuring that healthcare services are offered while maintaining the required quality standards. Many health organizations have been accredited through the Joint Commission, ensuring that safe, quality, accessible, and affordable services are provided. The regulatory agencies are also in the process of curbing medical malpractice that began in about a thousand years ago due to limited training and knowledge. Through research by AHRQ, the medical field has made significant steps to improving quality.
About the Joint Commission. (n.d.). About us. Leading the Way to Zero | The Joint Commission. https://www.jointcommission.org/about-us/
AHRQ. (2021). Mission & budget. Agency for Healthcare Research and Quality. https://www.ahrq.gov/cpi/about/mission/index.html
Anderson, N. (2017, May 10). A brief history of medical malpractice. Physicians News. https://physiciansnews.com/2017/05/10/brief-history-medical-malpractice/
Breslaw, E. G. (2012, October 12). What was healthcare like in the 1800s? History News Network. https://historynewsnetwork.org/article/149661
Hedrick, S., & Gingerich, B. S. (2006). The deemed status process. Home Health Care Management & Practice, 19(1), 69–71. Reisch, L. M., Carney, P. A., Oster, N. V., Weaver, D. L., Nelson, H. D., Frederick, P. D., & Elmore, J. G. (2015). Medical malpractice concerns and defensive medicine. American