Quality...

Quality is a nebulous concept.  What it means to me may mean something different to someone else.  In my own experiences I can identify high quality in well-made clothing, good restaurants, and nice cars.  I know that I often pay more for higher quality because I know the product will be better than others.  It will be excellent.  Superior.  The same every time.  Without defects.  I know when I’m treated right that I feel good leaving an encounter.  That’s quality customer service!  But quality can be hidden sometimes.  When I purchase a product for the first time, I may not know its quality level until after I use it.  Because of this, I love Consumer Reports.  It helps me find tested, quality products without the trial and error. 

 

I reflect on all these aspects as I think about healthcare quality.  How is it defined?  I think high quality is related to a superior patient experience, best clinical outcomes, lowest error rates, and a pleasant environment.  I work in the laboratory of a large hospital.  We have a constant focus on quality results.  This means that we provide accurate results in a timely fashion.  We strive to keep errors to a minimum and get the results to the nurse and doctor quickly.  A bad lab result can kill a patient, so there’s no room for error.  Our lab has many certifications, licenses, and accreditations.  These are distinctions that prove our quality, but we are constantly reviewing our metrics and scorecard to continually improve.  In my job I will never concede to lower quality.  It always comes first.

Hospitals that are Baldridge winners and ISO 9001 certified automatically are perceived as being higher quality institutions.  We’re striving for the same at my hospital.  The public may not know what these awards mean, but we do.  I think publicly reported measures are a great way for the public to understand the quality level of a hospital.  Just like Consumer Reports, these reports can provide quick guidance on the best place to get healthcare.  Patient satisfaction scores are now listed on the internet.  When we first saw the low HCAHPS scores from our hospital, we were horrified.  Then reality set in.  We are not meeting the expectations of our patients and we need to change.  If we are to achieve the highest quality, we need to impress our patients and exceed their expectations--- just like a fine hotel strives to go above and beyond in order to get repeat business.

I’ve been a patient in the hospital too.  It’s interesting being on the other side.  I noticed that I didn’t want to speak up to correct my nurse who was not using the best process or to ask a doctor to explain again the medications.  I hesitated because I didn’t want retaliation or to be perceived as a complainer.  I think many patients feel like this.  I think this needs to change.  As a patient, we should decrease tolerance for improper technique or attitudes.  We should speak up.  As a hospital staff member, we should keep the lines of communication with the patient and the family open and transparent.  We should encourage patients to tell us their concerns, so that we can overcome any bad impressions and move forward.  I think clinical quality has been easier to achieve than patient satisfaction.  We have a lot to learn about customizing our care.

 I have found that good quality often correlates to higher price.  I want to find a good deal just like the next guy, but, in general I find that I must pay a higher price to get the higher quality item.  Like my Coach purse or my Lexus SUV.  I’m not being pretentious.  I’m being sensible.  I know my purse and my car will last a long, long time because of their quality.  When I was first married we couldn’t afford good furniture, so we bought lower-end furniture.  It was crap and fell apart in a couple of years.  The fabric was not durable.  After growing in our careers and making more money, we bought nicer, higher quality furniture and paid more for it.  We’ve had that furniture for over ten years and it still looks great!  

Although I admit to paying more for higher quality products at home, I’m not convinced that higher cost correlates to higher quality in healthcare.  Previously, I listed several criteria that I think relate to healthcare quality.  Price wasn't one of them.  It is clear that the U.S. pays more per capita on healthcare, yet does not have the best outcomes to match.  This is where American healthcare needs to improve.  We need to be more efficient, promote preventive medicine, manage chronic diseases better, and provide universal access.  This will make progress in creating value for our healthcare dollars.