“What doesn’t get measured doesn’t get done.”-William Thomson
John is a 55 year old software engineer at a large firm in Manila. For four consecutive days now, he had episodes of vague “chest heaviness” coupled with some difficulty breathing. Privately insured, he asked for a day off to seek their company physician’s consult. He drove an hour to the clinic, waited for another two hours in the waiting room before being seen by the company physician lasting for 15 minutes. He was given a list of diagnostics and was referred to a cardiologist. The process of seeing a cardiologist is almost the same, only this time, much longer.
“Travel time was two hours because of traffic, waiting time doubled to four hours, diagnostics to 2 days yet being seen by a doctor lasted only for 8 minutes” said John. “I’m nervous. I’m not sure if its about my chest tightness or the whole rigodon of trying to determine what cause it. All I’m told it was a Non Specific T wave changes. I don’t even know what that means but it took me two weeks to finish the whole check up thing!”
Manang Tina is a 35 year old vegetable vendor. She temporarily stopped selling vegetables because her 7 year old daughter had a throat pain, difficultly eating food and fever for 3 days already. She asked her daughter’s teacher if she can be excused for a day. “I had to bring my daughter to the rural health unit” she said. At the RHU they had to wait for almost 4 hours before being seen by the doctor. Her daughter was seen and examined for 10 minutes. “She needs a CBC, a chest x-ray and urinalysis Manang Tina” said the doctor. “Have this done and come back here once the results are out. In the meantime, your daughter may take paracetamol and gargle with this liquid 3x a day” followed the doctor. The diagnostics took a week to finish, the fever and pain now gone and my daughter able to eat painlessly now. In fact she is already back in school. What shall I do with this lab results?” ask Manang Tina.
In this digital age, did Mr. John or Manang Tina’s daughter, received quality health care?
Quality of health care, defined
Agency for Healthcare Research and Quality of the US Health and Human Resources Department cite The Institute of Medicine’s definition of health care quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” I has six domains- effectiveness, efficiency, equity, patient centeredness, safety and timelines but has concomittant consumer perspectives of staying healthy, getting better, living with illness, and coping with end of life.
Complex, Divisive Issue
Quality of care is a complex, multi dimensional topic that most healthcare professionals avoid discussing. True enough, learning quality health systems and models could take some 4 or 5 years of formal study and a lifetime of iteration and improvements. Simplifying quality of care seems to be an impossible task for every health stakeholder. Everyone have the answer to quality issues yet our health system is going everywhere but forward.
“I leave that to experts” said Dr. D a busy private heart specialist. Dr. D is referring to quality assurance professionals, compliance personnel and regulatory agencies “to do their thing while we, healthcare professionals do what we’re good at- taking care of our patients.” We’re too busy to debate on such topic.” Dr. D explained.
But if a healthcare professional, a primary mover and health stakeholder doesn’t have a good grasp of what quality care is, how does one know he’s providing one?
“Look, I have a full, standing only waiting room at my clinic. If that’s not a measure of how patients see the quality of my care, I don’t know what is.” Said Dr. S a family physician.
Making quality care, personal
But how do we know we are giving the best of care to our patients? If you are a patient, how do you know you’re receiving quality medical care? What are our personal “yardstick” for “quality of care”? In the digital age where technological innovation has disrupted some areas of medicine- form intuition to precision diagnostics, did quality of care improved? How does this affect the present “business model” of physician’s practice? Of nursing care practice?
These are just some of the questions a healthcare professional, student or even patients must confront head on to improve health care. While healthcare professionals need help from external personnel for regulatory compliance and quality assurance, quality of care should be “personal” to every health stakeholder. In this technological age where innovations have the potential to improve some aspects of our health system, every health stakeholder has the responsibility of knowing what quality of health care is.
This is the topic of our #HealthXPh chat this Saturday 9PM Manila time. I’m inviting every health stakeholder out there- patients, healthcare students, healthcare professionals etc, join in your personal views on quality care in this interesting chat. In your personal practice ( if an MD, Nurse, allied professional), plan (if you are a student), experience (if you are a patient),
- T1. What is your personal idea of quality health care and how do you measure it?
T2. Name one innovative step you implemented to improve quality of care in your practice.
T3. Name one technological innovation that should improve quality of healthcare in 3-5 years. Explain
References:
William Thomson (June 26, 1824–December 17, 1907), 1st Baron Kelvin, often referred to simply as Lord Kelvin, was an Irish mathematical physicist. https://en.wikiquote.org/wiki/William_Thomson
Understanding Quality Measurement. Content last reviewed July 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/understand/index.html
Christensen, Clayton M., Jerome H. Grossman M.D., and Jason Hwang M.D. The Innovator’s Prescription: A Disruptive Solution for Health Care. McGraw-Hill, 2009.
