How Should We Define Quality in Healthcare?

If I had to define what quality means in the most general sense, it would be how well something satisfies my expectations. When I go grocery shopping at Whole Foods (my favorite grocery store) I expect the quality of the produce as well as the selection to be at a certain level—superior to what I might find in a Wal-Mart or Target produce section. My guess is that my expectation of Whole Foods is derived from my experiences there and fact that the groceries are more expensive—but that’s just the price of eating organic.

Even though my previous definition of quality is a suitable measure for Whole Foods and other retailers or businesses, it doesn’t work so well when it’s applied to healthcare. Measuring health care quality against patient satisfaction alone is very short-sighted. The problem is that when it comes to the science of medicine, patients don’t really know what to expect. They know that a receptionist should be kind and courteous and that they shouldn’t have to wait two hours to see the doctor, but they don’t necessarily know what medications or therapeutic approaches would be best for their condition. They’re trusting the doctor who went to medical school to tell them that. Doctors are brilliant people, but they’re still human and capable of making errors that can result in reduced quality for the patient.

I like the Institute of Medicine’s (IOM) definition of quality: “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Ransom, 2008). That sums up the definition of quality nicely, I think. If the doctor is practicing evidence-based medicine by following the protocol of current research, then regardless of the outcome the patient is getting the best quality of care that the medical community knows how to give.

The IOM definition is appropriate in terms of simply defining quality, but the six dimensions of quality as illustrated in Crossing the Quality Chasm reveal more insight on how to actually measure it. The six characteristics of quality answer this question: Is the healthcare delivery safe, effective, efficient, timely, patient centered, and equitable? If the answer is yes then it’s probably safe to say that the care the patient received was of high quality (Ransom, 2008).

In the wake of the healthcare reform, many Americans are wondering how the new legislation will affect healthcare quality. I’m actually wondering the same thing. As a pharmaceutical rep, I interact with primary care physicians every day. Many of them are already struggling under a demanding patient load and reimbursement cuts make it financially difficult for these doctors to see fewer patients. I think that the quality of care is already suffering in these offices due to time constraints, and it makes me wonder what will happen to healthcare quality overall once the whole bill is in effect.

Another interesting aspect of healthcare quality is the integration of new technology, a service feature that the U.S. health system is never short on. Lighter and McLaughlin make important points in The Rationale for Quality Improvement in Healthcare. They discuss the conundrum that the health care system is in regarding the demand for new technology by the consumer and the cost-containment pressures that come from several different sources. Culturally, I think that Americans are conditioned to believe that more is better. There seems to be this preconceived notion that if something costs more then that inherently makes it better quality than a comparable, but less expensive product or service. This mentality might have filtered into the healthcare system as well.

Even though state of the art technologies are in demand from consumers, the reality is that we can’t afford it as a nation. The pressure to get costs under control has resulted in a managed care system that is sometimes a bit too restrictive for the provider’s taste. Lighter and McLaughlin state, “Observing the effects of cost containment on patient utilization patters, providers often express concern that payers sacrifice quality for reduced cost.” There seems to be a very fine line between ensuring quality and controlling overall costs. What’s even more complicated is the fact that healthcare is still a business and organizations are focused on the bottom line which isn’t always in the best interest of the patient.

The U.S. definitely needs a better system of “checks and balances” so that more patients receive higher quality of care. The question is, how do we create that system and what does it look like? Hopefully, I’ll have a better understanding once I complete this summer semester.

References

Ransom, E., Joshi, M., Nash, D., & Ransom, S. (2008). The Healthcare Quality Book (2nd Ed.). Chicago: Health Administration Press.

Lighter, D., McLaughlin, C. The Rationale for Quality Improvement in Healthcare.