Are You Providing Quality Healthcare?
One of the new buzzwords in medical care today is “quality.” Are you providing quality healthcare? It sounds very neat and uplifting but let us dissect the word as it applies to us in some practical ways.
How can you know if you are providing quality care? Should you be satisfied with a “yes” answer with a good clinical outcome (whatever that means), spot-on radiographs and a satisfied patient? You utilized a really expensive screw(s) versus your colleague who has all the same results as you but his screws were one-fourth the cost of yours? Is that better quality? Gotcha!
How do patients know they received quality care? After all, they are not physicians or perfectly nuanced in the intricacies of your knowledge and care. They did like your tie and office staff in spite of not being able to wear all their shoes after that bunionectomy. Will they say you provided quality care based on your appearance, bedside manner and/or surgical results? By the way, if your patients can only wear flats now, is that quality care?
Don’t forget, one doctor’s quality can be another’s poor results. Maybe this quality paradigm forgets that how one heals, how one listens and the myriad of factors out of our control can impact “quality.” Does your quality evaluation by the powers that be take those factors into account?
Industry is heavy into the quality thing when manufacturing, for example, a car. The automotive industry has its own self-analysis regarding all the parts and is able to apply its own quality standards to the finished products. No or poor quality equals no or few sales. Customers can kick the tires, take the car for a test drive and find out all they want to know on the Internet. They become pseudo-experts before the purchase.
Think about it. The same quality philosophy is being applied to medicine. You let me know how patients can test drive their bunionectomy but your quality, which initially will be a rating/score and a possible payment reduction later, may hinge on a patient’s conception of quality care. Healthcare is not as easily measurable as that car. Go figure but that is the way we are headed. A skeptical colleague looks at all of these shifts and lumps them under the rubric: “Just another way to reduce payment.”
Do you think Grandma will rate you higher after reduction of her mycotic nails versus the patient who had a large bunion treated with surgery but cannot wear those five-inch heels? Will your hospital receive a higher rating from a patient with newly diagnosed diabetes who had to have an emergent transmetatarsal amputation or from the patient who stayed one night after repair of a lateral malleolar fracture?
Without a doubt, quality is something to strive for. If you really stop to think, though, in medicine, it is not as easy to define or measure “quality.” Also, the bar can easily move. Today’s quality is tomorrow’s “you are not even close.” Will any quality score show up in a malpractice case? If it does, I would love to see how both sides use it during the trial.
Our electronic medical records provide quality if you look at the information at our fingertips. Is entering mundane information not germane to the visit quality? How about the physician who keeps typing on the computer who keeps his or her back to the patient and ultimately decreases face time? Do you think that patient perceives quality? If those patients’ perception of quality is low and there is a rating, how do you think you will fare?
Saving the best for last, where does patient compliance fit in? Will it be factored in your quality determination? We all know that a non-compliant patient can wreak havoc on your hard work. You also know these patients very rarely take ownership of their non-compliant behavior. Now what?
Just like beauty, quality may be in the eye of the beholder. Unlike beauty though, an entity will request a questionnaire regarding quality, apply a “score” and just maybe finagle the payment. What recourse do we have? Naturally, doing your best in every aspect of practice will go a long way toward that quality rainbow. Even with your best effort, quality may still be elusive. At the end of the day, take solace that you did your best.
As a Little Rascal once said in an episode: “I don’t know where we’re going but we’re on our way.”
Dr. Wallace is the Director of the Podiatry Service and the Medical Director of Ambulatory Care Services at University Hospital in Newark, N.J.
