Defining quality care

A couple of readers let me know offline that they disagreed with a post last week examining the implications of Minnesota’s newly released quality performance scores for clinics and hospitals. Their objections can be summarized as: “Why are you anti-measurement and anti-consumer?”

For the record, I am neither. Performance measurement is a valuable tool to help providers know how they’re doing. Without it, there’s no way to objectively know whether they’re truly delivering the best evidence-based care or whether they just think they are. Consumers also deserve to know how their provider stacks up against the standard of care. If nothing else, embarrassment over the public reporting of less-than-stellar scores can be a spur for providers to try to improve.

We shouldn’t be misled, however, into thinking that percentages on selected measures are the sole way to gauge whether a provider offers quality care. It’s critical to keep in mind that performance scores represent only some of the activities that take place daily in Minnesota clinics and hospitals. It’s also critical to remember that they’re based on a sample of patient data, and don’t represent every patient encounter.

If performance scores aren’t the whole story, then what is? I’m not sure there’s any universally accepted definition of what constitutes quality hospital or outpatient care. To some extent, quality is in the eye of the beholder. But to borrow Justice Potter Stewart’s famous definition of pornography, I know quality when I see it.

These are some of the things I would want to see in a quality provider (and readers are invited to add their own in the comment section):

– A culture of excellence for every process that touches the patient.

– A commitment to recruiting and hiring good people and giving them ongoing training and support.

– The ability to think in terms of systems rather than silos.

– Knowledge of the community in which they practice and the populations they serve.

– Recognition that patients are individuals and cannot be reduced to labels or cookbook medicine.

– Rigorous attention to patient safety and to examining and improving processes to reduce the likelihood of error.

– Accountability for errors, both for close calls and for actual harm to patients.

– Responsive to emerging needs and issues.

– Up to date in knowledge.

- Purposeful in seeking feedback from patients and finding ways to engage them in ongoing dialogue about the patient experience and how to make it better.

– Willing to be a partner with other community organizations.

- Innovative in finding new ways to meet patient and community needs.

– Good stewards of resources who are careful about unnecessary treatment and make wise decisions about investing in technology and new services.

It’s extremely difficult, perhaps even impossible, to quantify and measure these things, yet they’re vitally important to delivering good care. And therein lies the issue with performance scores: When numerical scores are touted as the measure of whether a provider is good, it can downplay or ignore other critical factors in favor of sheer numbers and statistics. And when this happens, the risk is that quality will ultimately be reduced to the things we can objectively measure, never mind all the rest of it. Is this seriously what we want for health care? I think you know how I would answer that question.

HealthBeat photo by Anne Polta

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