What is Quality?
There is much written about America's "best" hospitals and doctors. Entire national magazine issues are dedicated to such proclamations. Whole industries have popped up to measure "quality." So much in fact that one would think everyone knows what "best" means. What is quality? In fact, when pressed, many physicians and nurses haven't a clue as to what metrics go into assessing the quality of care delivered by their hospital.
Many will seize upon the catch phrase, "evidence based medicine" and claim that it is the best docs and centers that practice this. Of course one next must define what is meant by evidence based care and we are often met with blank stares. Please do not mention that over 40% of patients do not receive the recommended care due them. And of course there are those pesky 15 million episodes of patient harm that must be happening at some of these best hospitals with some of these best doctors...98,000 people [at least] die every year due to medical errors.
The Institute of Medicine has defined the domains of quality healthcare and one finds the true answer within these areas. Quality care must be safe, patient centered, timely, clinically effective, equitable and efficient.
Patient safety is first and foremost. If it isn't safe, who cares how timely the care is. If you go to the world's best surgeon, at the best hospital, and during the operation they drop you off the table and hit you with the xray machine, does it matter how effective the medical care was? No, now you have a host of new problems to deal with!
Patient centeredness means we develop and operationalize ALL processes in the hospital with our patients at the center of the equation. To take a page from Toyota, we remove all steps of no value to our patients... For instance: How much would you pay me to sit and wait in my fancy outer office, reading current magazines? Nothing? Why? Isn't waiting important to you?? Of course it isn't and should not be part of any hospital planning process. Yet every time a new clinic or ED is built, there are the large and comfortable waiting areas, complete with flat screens and bathrooms, etc. The message: Be prepared to wait for us - a long long time.
Waiting rooms are monuments to failed processes.
There is no reason to keep your customers waiting, if you schedule your staff and appointments correctly. If you employ queuing theory and plan the delivery processes out. There are many strategies available that have proven track records and are widely available. In the 21st century can we figure out how to treat people with dignity and respect in a timely manner?
As you can see timeliness and patient centeredness are intertwined. We often measure the patients' satisfaction using validated survey tools. Timeliness is studied by looking at how long one waits to be examined in the ED or when the next available appointment is open in primary care clinic [or the third next available appointment actually]. Also studied is the amount of time one spends admitted to the hospital for a particular illness or surgery, we call this the length of stay.
Clinical effectiveness is viewed simply: Was the proper care delivered with acceptable outcomes. We study processes of care and outcomes measures, like mortality. Some of these are publicly reported on the Hospital Compare website [ www.hospitalcompare.hhs.gov ] maintained by the Hospital Quality Alliance, which is made up of such organizations as Medicare, the American Hospital Association, the American Association of Medical Colleges and the US Department of Health and Human Services, to name only a few.
Effectiveness is where evidence based medicine kicks in: Making the right diagnosis and prescribing the best treatment. Therapy that is supported by scientific literature and generally agreed upon by experts. [Another mouthful, but we will save that for another day - suffice it to say, "there are no randomized, controlled trials to support the use of parachutes in effectively saving your life when jumping from a plane at 5,000 feet, however we still employ their use."]
Equity and efficiency are really traits of the healthcare system as a whole and are studied regionally. Although most hospitals do study their cost efficiency quite deeply in order to stay alive and competitive, it is really as it effects the public health that matters most to the viability of the system. Equity is studied along ethnic, racial and gender boundaries and is also of most importance to the public health around issues of access and equal treatment without bias.
Quite a bit goes into assessing the healthcare quality of any hospital. It is quite a mouthful to state that one hospital is "better" than another. Unfortunately many of these "best of" lists are popularity contests, or exercises in name recognition. Could St Joe's Hospital in West Nowhere, South Dakota ever hope to be ranked with Duke or Massachusetts General? Probably not. Though the dedicated staff there may be doing an outstanding job for their patients.
At least now you have been introduced to some of the scientific concepts that go into objectively making the quality of care assessment. Check out Hospital Compare and also the links in this site to continue your learning. More later... Thank you.
Many will seize upon the catch phrase, "evidence based medicine" and claim that it is the best docs and centers that practice this. Of course one next must define what is meant by evidence based care and we are often met with blank stares. Please do not mention that over 40% of patients do not receive the recommended care due them. And of course there are those pesky 15 million episodes of patient harm that must be happening at some of these best hospitals with some of these best doctors...98,000 people [at least] die every year due to medical errors.
The Institute of Medicine has defined the domains of quality healthcare and one finds the true answer within these areas. Quality care must be safe, patient centered, timely, clinically effective, equitable and efficient.
Patient safety is first and foremost. If it isn't safe, who cares how timely the care is. If you go to the world's best surgeon, at the best hospital, and during the operation they drop you off the table and hit you with the xray machine, does it matter how effective the medical care was? No, now you have a host of new problems to deal with!
Patient centeredness means we develop and operationalize ALL processes in the hospital with our patients at the center of the equation. To take a page from Toyota, we remove all steps of no value to our patients... For instance: How much would you pay me to sit and wait in my fancy outer office, reading current magazines? Nothing? Why? Isn't waiting important to you?? Of course it isn't and should not be part of any hospital planning process. Yet every time a new clinic or ED is built, there are the large and comfortable waiting areas, complete with flat screens and bathrooms, etc. The message: Be prepared to wait for us - a long long time.
Waiting rooms are monuments to failed processes.
There is no reason to keep your customers waiting, if you schedule your staff and appointments correctly. If you employ queuing theory and plan the delivery processes out. There are many strategies available that have proven track records and are widely available. In the 21st century can we figure out how to treat people with dignity and respect in a timely manner?
As you can see timeliness and patient centeredness are intertwined. We often measure the patients' satisfaction using validated survey tools. Timeliness is studied by looking at how long one waits to be examined in the ED or when the next available appointment is open in primary care clinic [or the third next available appointment actually]. Also studied is the amount of time one spends admitted to the hospital for a particular illness or surgery, we call this the length of stay.
Clinical effectiveness is viewed simply: Was the proper care delivered with acceptable outcomes. We study processes of care and outcomes measures, like mortality. Some of these are publicly reported on the Hospital Compare website [ www.hospitalcompare.hhs.gov ] maintained by the Hospital Quality Alliance, which is made up of such organizations as Medicare, the American Hospital Association, the American Association of Medical Colleges and the US Department of Health and Human Services, to name only a few.
Effectiveness is where evidence based medicine kicks in: Making the right diagnosis and prescribing the best treatment. Therapy that is supported by scientific literature and generally agreed upon by experts. [Another mouthful, but we will save that for another day - suffice it to say, "there are no randomized, controlled trials to support the use of parachutes in effectively saving your life when jumping from a plane at 5,000 feet, however we still employ their use."]
Equity and efficiency are really traits of the healthcare system as a whole and are studied regionally. Although most hospitals do study their cost efficiency quite deeply in order to stay alive and competitive, it is really as it effects the public health that matters most to the viability of the system. Equity is studied along ethnic, racial and gender boundaries and is also of most importance to the public health around issues of access and equal treatment without bias.
Quite a bit goes into assessing the healthcare quality of any hospital. It is quite a mouthful to state that one hospital is "better" than another. Unfortunately many of these "best of" lists are popularity contests, or exercises in name recognition. Could St Joe's Hospital in West Nowhere, South Dakota ever hope to be ranked with Duke or Massachusetts General? Probably not. Though the dedicated staff there may be doing an outstanding job for their patients.
At least now you have been introduced to some of the scientific concepts that go into objectively making the quality of care assessment. Check out Hospital Compare and also the links in this site to continue your learning. More later... Thank you.
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