What is “quality” in healthcare?
It turns out it depends on who you ask.
Doctors tend to view quality from a technical perspective – accuracy of a diagnosis, appropriateness of the treatment, and the outcome for the patient.
Payers (which includes Medicare and Medicaid, and commercial insurance) tend to focus on evidence-based medicine (documentation that a treatment or intervention works consistently) and cost-effectiveness.
These are the definitions we all hear about in the news. But it’s not often enough that the patient view of quality is discussed.
The Department of Community and Family Medicine at Duke University prepared a training module on quality improvement in healthcare that defines the patient view of quality as “Compassion as well as skill with clear communication.” Personally, I really like that definition.
A multi-year research project conducted by The Picker Institute ultimately identified eight characteristics of what quality looks like through patient’s eyes:
- Respect for the patient’s values, preferences, and expressed needs
- Coordinated and integrated care
- Clear, high-quality information and education for the patient and family
- Physical comfort, including pain management
- Emotional support and alleviation of fear and anxiety
- Involvement of family members and friends, as appropriate
- Continuity, including through care-site transitions and access to care
When you think about the best interactions you’ve had with the healthcare system, how many of these measures occurred for you? When you think of the least satisfactory healthcare encounters you had how many of these measures were missing?
Even as we know other partners in our care may be focused on “quality” through a different lens, as patient-consumers (or advocates for patients) it’s on us to talk about what matters personally to us with the individuals that deliver our care.
How can you help your doctor or other caregiver deliver quality care from your perspective to you or a loved one? Here are some thoughts:
- If your preference is to be addressed by as Mr. or Ms. Last Name, or by your first name, let your care provider know and consider asking them also how they want to be addressed by you. If want them to look at you rather than their computer when they’re asking you questions, let them know. And be prepared to have to tell them a second, and maybe a third time. Given the number of patients doctors, nurses, and other caregivers see in a day, week, or a month, cutting them some slack for not remembering what’s important to you after one encounter demonstrates that you understand relationships take time.
- Stop a healthcare provider who uses a term you aren’t familiar with. Ask them to explain it to you.
- When a doctor says, “this may be a bit uncomfortable” their definition of uncomfortable and yours may vary considerably. Ask what you can do or have prescribed to make your care more comfortable. A consult with a palliative care or pain specialist might also be helpful.
- Admit it when you’re anxious or afraid. Our providers can’t help us address anxiety or fear when we keep a stiff upper lip. And if your provider isn’t willing to address your emotional health, ask if they would order a consultation with a specialist who will.
- Having family and friends as part of our team can be a critical component to our health and wellbeing, not to mention amplifying our voice when we can’t speak for ourselves. Make sure your health care team knows who they can speak with about your care and who you trust to speak for you if you can’t speak for yourself.
- Transitions in care are often times when the communication ball gets dropped. When a change in place of care or a referral to a new provider is made, ask how pertinent information will be shared and if you can review the orders for the new provider so you or a private patient advocate can fill in the gaps.