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To
evaluate means to judge the value, quality or outcome of something
against a predetermined standard.
At a district hospital, the act of evaluation will generate
information that will enable a judgement to be made on whether
the hospital is providing high standards of care and is making
the best possible use of resources, including:
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Performance
of staff, equipment or a particular intervention |
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Clinical
effectiveness of a type of treatment |
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Efficiency
in relation to the use of resource (cost-effectiveness). |
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It
may be a community in its own right |
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It
must be involved in community public health education and
political solutions to common health problems. |
Evaluation is part of a continuous loop of information gathering,
analysis, planning, intervention and further evaluation and
involves the following steps.
| 1 |
Set
goals and targets. |
| 2 |
Define
indicators (previously stated standards, intended results
or norms) that can be used to assess whether these goals
and targets are being met. |
| 3 |
Collect
information to measure observed achievements. |
| 4 |
Compare
achievements with goals and targets. |
| 5 |
Identify
any deficiencies or failures and analyse the causes. |
| 6 |
Identify, plan and implement any interventions required
for improvement, such as training. |
| 7 |
Re-evaluate
and identify any further interventions required. |
Evaluation may be as simple as asking the question “Are
all babies weighed in the outpatients department?” If
the answer is “No”, the next step is to ask the
question “Why not?” and to use the answer to identify
possible steps to resolve the problem.
Evaluation will often be more complex, however. For example,
a hospital recognizes that it has very high postoperative wound
infection rates. All potential sources and causes of postoperative
infection are studied and, after careful review and consultation,
a plan is developed and implemented. After a defined period
of time, a review of postoperative wound infections is again
undertaken as a measurement of observed achievement. This is
then compared with both previous results and expected outcomes.
If there has been a drop in the infection rate, the team can
decide whether the desired outcome has been achieved and whether
the measures taken should be adopted as regular practice. By
changing only one thing at a time, it is possible to determine
whether any improvement is related to the intervention. If the
intervention does not result in the desired change, it is important
to identify why it has been unsuccessful before trying another
intervention.
Chart audit
Patient charts contain important information about individuals,
their illnesses and course in hospital. This is valuable information
for evaluation. If records are kept after patients have been
discharged, a chart audit can assist in monitoring the services
provided by a hospital, diagnosing areas of concern and identifying
areas for improvement, including:
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Consistency
of approach |
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Infection
rates |
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Length
of patient stay |
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Transfusion
rates |
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Complication
rates. |
A
chart audit involves the following steps.
| 1 |
Ask
a specific question, such as “What is our postoperative
wound infection rate?” |
| 2 |
Define
the period of time for which the charts to be monitored
will be selected. |
| 3 |
Define
the size of the sample of charts to be reviewed. |
| 4 |
Develop
a system for tabulating the data. |
| 5 |
Make
a systematic review of the charts of patients who had surgery
during the defined time period. |
| 6 |
Collate,
analyse and interpret the results. |
Once
the wound infection rate has been documented, it is possible
to assess whether it is acceptable. If it could be lowered,
an improvement strategy can be devised and implemented. After
a period of time, a second chart review can be undertaken, the
change evaluated and adjustments made to practice.
Evaluation takes time and effort, but is a necessary part of
a commitment to quality care.
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