(This is a guest blog from the Chief Medical Officer of Chippenham & Johnston-Willis Hospitals, Dr. Michael Menen.)
There is a lot of talk about quality metrics, pay for performance, value-based care, and penalties for poor outcomes. Hospitals have been using a variety of strategies to improve quality for decades. In this regard, it’s useful to ask a basic question. What is quality? Well, it depends! It depends because many different factors make up quality, and many different perspectives.
Quality in healthcare may include, for example, the safe use of prescription drugs, the training of healthcare professionals, effective medical information technology, good processes, and top-notch medical technology. Quality may also include nice surroundings, efficient registration, good patient transport, and clean rooms.
We measure quality indicators like compliance rates, complications, and adherence to protocols, all of which are important in helping us improve patient care and safety. But at the same time, there are very important aspects of quality that cannot currently be quantified. For example, we have no yardsticks for technical expertise, critical thinking, fund of knowledge, good judgment, compassion, curiosity, or relentless determination to do best by each patient.
Quality also depends on your point of view. To an insurance company, low lengths of stay may indicate quality. A clinic manager likes providers who get patients seen more quickly and efficiently. Risk managers want no unnecessary testing, but also no missed diagnoses. Patients should get health care without delay, treatment without harm, and only the medical tests necessary for diagnoses.
Because there are so many competing quality interests and perspectives, the different elements of quality are sometimes difficult to reconcile In other words, if you want fewer missed cancers on chest X-ray, there will be more negative CAT scans for questioned findings on chest X-ray. Newer medications and technologies, often desired for their great promise curing disease, have shorter track records and may be more risky.
In many industries, enhancing quality is an effective strategy for improving financial performance. Companies that invest in quality can eliminate waste, gain market share, or command a higher price. Experts in quality improvement generally believe that improving quality in health care – despite the costliness of some approaches – will similarly result in improved financial as well as patient outcomes. In the current health care system, investments in quality – while producing net economic benefit for society – do not routinely translate into improved financial performance. The absence of evidence that health systems, providers, and others who invest in quality improvement will see a return on investment within a reasonable time frame is widely acknowledged to be one of the most important obstacles to improving health care.
The challenge – quality improvement lies in making stakeholders aware of the financial benefits of good care. The successful creation of an economic motivation to improve quality will most likely depend on the ability of theses stakeholders to come together, motivated not by short-term economics, but by a long-term commitment to an improved health care system. Making health care function will likely require ending business as usual, and will most likely include:
- Expanding public access to performance data for different providers
- Educating the public about what is included in excellent care
- Better aligning the financial incentives of the system with improved patient outcomes
- Decreasing the fragmentation of the health care system
- Promoting a shared sense of public stewardship
Continued investment and attention to quality should be our greatest priority, as we strive to provide the best health care possible.
What does quality mean to you? Leave a reply for me here.