Healthcare quality is a hot topic these days and a very polarizing one too. I think the polarization probably comes from a misunderstanding of what Quality is and intends to do. In some corners of healthcare, quality is equated with satisfaction scores, or it may equate to cost cutting maneuvers. This is sad because when leaders become myopic about quality science and only find value in moving a number there is the potential for a big let down.
Using satisfaction scores as an outcome measure (an outcome measure is a metric that is the ultimate goal) for example undervalues actual health measures like mortality rates, bounce back rate, or opioid addiction rates. I think this is why many clinicians begin to either shut down or become red-faced angry when we talk about patient satisfaction. Yet, I do not think any of us would disagree that if all healthcare outcomes were the same, we want patients to have the most favorable experience possible. This is to say, its not the outcome measure but rather a process measure (a process measure is a metric assessing one part of a system or a process that leads to a final outcome) or maybe a counterbalance measure (a counterbalance measure is a measure of an aspect of care we don’t wish to negatively impact as we implement changes).
Quality simply works to make processes better so as to make outcomes better. In healthcare, we have done this. Think of the way people with ST-elevation myocardial infarctions were cared for twenty years ago compared with today. Not everything that has improved their care was developed in a pharmaceutical lab. Much of the improvement has been in the way that we interact with the patients and we interact with each other. Empowering prehospital providers to activate catheterization labs, building trust between cardiology and emergency medicine, prioritizing certain testing, creating order sets, etc. have all reduced wasted time, reduced redundant testing, and led to improved mortality rates and morbidity rates. We are not done, but our processes are better and our outcomes are better than they have ever been.
The next time you are feeling yourself tense up when the word Quality is mentioned, remember, if you apply the science in the right way, you and your patient will have a better tomorrow.
If this is resonating with you, check out my summary video: