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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Defining high quality health care.

Matthew R Cooperberg¹, John D Birkmeyer, Mark S Litwin

¹Department of Urology, University of California, San Francisco, San Francisco, CA 94143, USA. MCooperberg@urology.ucsf.edu

Urologic Oncology

|July 4, 2009

Summary

Health care quality improvement uses structure, process, and outcome measures. While surgical volume is a structural measure linked to outcomes, its impact is debated, highlighting challenges in quality improvement efforts.

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Last Updated: Jun 21, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Area of Science:

Health Services Research
Quality Improvement Science

Background:

Health care quality improvement initiatives commonly assess structures, processes, and outcomes.
Outcome measures, while most valued by patients and clinicians, are complex due to patient and environmental factors influencing results.
Surgical volume, a structural measure, is increasingly considered in healthcare policy due to its association with health outcomes.

Purpose of the Study:

To review the different types of measures used in health care quality improvement.
To discuss the role and controversies surrounding the volume-outcome relationship in surgical care.
To highlight the challenges and future directions for health care quality improvement.

Main Methods:

Review of existing literature on health care quality improvement measures.
Analysis of the volume-outcome association in surgical care.
Discussion of methodological, clinical, financial, and political challenges in quality improvement.

Main Results:

Structural measures assess fixed aspects like resources; process measures evaluate clinical transactions; outcome measures assess results like mortality.
A positive association between surgical volume and outcomes is frequently observed, influencing policy decisions.
The volume-outcome link is debated, with limitations in data and potential negative impacts on access to care.

Conclusions:

Health care quality improvement is a growing movement facing significant challenges.
Physicians must take leadership roles in defining, measuring, reporting, and improving care quality.
The selection of quality measures should be guided by the specific clinical context.