What is quality in healthcare?

In the previous entry, we discussed what value is and what the term means for healthcare services.

Value is the provision of high quality healthcare service and outcomes at minimal cost necessary.

This definition prompts certain questions for most people, specifically:

What is quality and how do you measure it?

This is a good question to pose, as the term quality carries a different meaning for different sectors and is subjective even within healthcare. In summary,

It is important to realize that quality in this context is not a simple quantification of provider skill. Quality in healthcare is a complex measurement that can include efficiency, patient satisfaction and medical outcomes among others and can be very subjective. In the above equation, Performance replaces Cost from the previous blog’s equation as the impacts of Value and Cost on Quality are not necessarily proportionate. Increasing cost does not necessarily mean the quality of healthcare will improve. Performance however, can be a better factor in determining the quality of care. Performance can be comprised of: Efficiency, Patient Satisfaction and Medical Outcomes.

Efficiency in healthcare is a measurement that is mostly decided by the volume of redundant procedures performed. Redundant procedures in this case can mean procedures that must be performed multiple times due to negligence or poor inter-physician coordination. For example, if a primary care physician orders x-ray scans from an outpatient diagnostic imaging center, but does not share those x-ray images with the hospital performing the surgery (where they perform their own identical scan); that second x-ray was a redundant service and a waste of patient time (and perhaps money) and hospital resources alike.

The measurement of efficiency relies on the collection and analysis of large pools of healthcare data.

Patient satisfaction for healthcare is an aspect of quality that reflect patient feeling and experience. This includes: Whether a provider made the patient feel safe and well cared for and whether communication between provider and patient was satisfactory, among other things.  Measurement of patient satisfaction relies largely upon patient surveys either paper or digital.

Medical outcomes are the end result of a period of medical care. Outcomes can be positive or negative, but measuring outcomes for the purpose of establishing quality can be a tricky endeavor. This is because it is often the case that a negative outcome does not equate to low provider ability or negligence, but rather spontaneous acts of the human body. If a patient passes during surgery, for example, it is a negative outcome, but it is not appropriate to deem the surgery low quality based on that fact alone. If however, when compared to a national average, the same hospital had a much lower rate of post-surgery survival, conclusions may be drawn to measure the quality. Medical outcomes measurement usually has to do with areas such as mortality and readmission rates.

So to define quality as the product of performance and value (which includes efficiency, patient satisfaction and medical outcomes) is no easy task. The conversion on how to fairly characterize, measure, and utilize healthcare quality data is an ongoing one.