The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care / This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors / This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers / The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive / This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode / This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession / This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives / Thesis (PhD)--University of South Australia, 2005
| Identifer | oai:union.ndltd.org:ADTP/283828 |
| Date | January 2005 |
| Creators | Kumar, Saravana |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | copyright Saravana Kumar 2005 |
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