BB’s Healthcare Quality 101

healthcare quality 101

What exactly is healthcare quality and am I getting the best healthcare quality from each of the healthcare providers and hospitals I use?  Is the treatment proscribed by my medical provider the “best” quality of care or is it limited by his lack of experience, knowledge, or desire for increased income?  Is the care delivered simply defined by what the health insurance company will pay for rather than what is best?  Am I being sold not to look for or to ask for healthcare quality?

Research has shown that patients in the United States receive the proper diagnosis and care only about 55% of the time and a wide variation in healthcare quality, access, and outcomes is common across the United States.  Our healthcare services are frequently underused (due to affordability issues), misused (due to individual practitioner variations in care ), and overused (for profit) as a result. Furthermore, our system of individual healthcare provider businesses serves to deliver fragmented, overly complicated, and uncoordinated care that can lead to serious harm or even death.

Currently, the U.S. health care system is built around money and not quality.  Efforts to improve poor healthcare quality in the United States are relatively new (Obamacare (PPACA) reforms) and slow to filter down to all Americans. Let’s look at what actually makes up healthcare quality in more detail.

The Components of Healthcare Quality

healthcare quality componentsHealthcare quality is about delivering effective and safe care that is patient-centered and coordinated for timely treatment. It must be delivered with cost efficiency and affordability. Quality of healthcare must be equitable (benefiting ALL Americans without prejudice). Healthcare quality stands on its own merits. Let’s look at each of these underlined components of healthcare quality below.

  1. Effective care

Effective care  refers to “services that are of proven value”.  It is appropriate for preventing or treating a given condition and controlling chronic illness. In effective care, “the benefits of the services so far outweigh the risks that all patients with specific medical needs should receive them”. Widespread agreement on “proven value” is usually based on evidence-based clinical data that has shown which treatments deliver the “best” outcomes in a large patient population.  In the United Kingdom, the National Health Service uses the latest evidence-based clinical data to create “best practices” guidelines that all healthcare professionals must fully take into account as the foundation for treatment.

Effective care ensures that all patients receive the right care, at the right time, in the right setting, every time. Effective care also means withholding care from those not likely to benefit. Variations in effective care can occur based on the individual patient’s specific needs, preferences, and values (i.e., care is patient-centered). Effective care is defined by clinical research and by how it affects the income and profits of healthcare businesses.

Examples of effective care include:

  • Eye examinations every two years and annual A1c blood screenings for diabetic patients
  • The use of beta-blockers and aspirins for people who have had heart attacks
  • Annual vaccination against the flu

2. Safe Care

Tens of thousands of Americans die each year in healthcare facilities across the country as a result of preventable errors, unsanitary conditions, and sloppy adherence to accepted medical practices. When a person goes to a healthcare provider or hospital, they should be safe from harm caused by the care system. In other words, going to a doctor or hospital shouldn’t make you sicker than when you first arrived.  This would be like going to an auto shop to get a dent fixed and coming home with two dents after paying the bill.

Safe care is of most concern in the hospital (or nursing home) setting, where unhealthy conditions and practices can lead to diseases on top of those already present in the patient. Hospital care must be managed so that patients do not pick up hospital-based infections (e.g., from dirty IVs or catheters), infectious diseases from poor containment procedures, or complications from improper or sloppy procedures.

When a healthcare company is not held accountable for unsafe practices, it can skimp on the cost of safety management. In fact, when a healthcare business practices create more sickness, it can be financially rewarded when it subsequently treats the condition it created.  Years ago, my mother-in-law developed a bed sore after a two day hospital stay (from inadequate adult diaper change) and had to pay for subsequent out-patient wound care provided by the same hospital whose conditions created the bed sore.

3. Coordinated, Timely Care

A person is not a collection of parts and quality of healthcare will never improve until our healthcare system stops treating patients as if they are. The lack of coordination and communication between general practitioners and medical specialists (incorporated as separate businesses) hinders the delivery of the best healthcare quality in the United States.  As a collection of parts, patients are marginalized by the professional stakeholders in healthcare and their contributions to coordinated care are largely unwelcome.

Timeliness is also an important aspect of coordinated care both in treatment and in dissemination of health records to the entire healthcare coordination team (patients included). Shortages of doctors (especially specialists) affects timeliness of treatment and must be addressed by our government so that people do not get sicker or even die waiting to see an in network healthcare professional.  All health records (preferably electronic) should be available to all involved for care coordination in a timely fashion.  This will eliminate testing duplication, reduce errors in diagnoses, and foster a more efficient path to better outcomes.

4. Patient-centered care

The delivery of quality patient-centered care looks at the needs of the patient first and foremost.  Practices that safeguard and increase the income and profits of healthcare businesses over patient care is NOT patient-centered care.  Simply attaching the name “patient-centered” to health care, does not make it so.  Quality patient-centered care means providing care that is respectful of and responsive to individual patient preferences, needs, and values. Quality care delivery ensures that each patient (and patient advocate) is engaged as partners in all steps of the process. Our healthcare system must be designed to deliver a minimum quality standard of care and must be able to accommodate differences in patient preferences. The patient must be given the necessary information and opportunity to exercise the degree of control they choose over health care decisions that affect them.

Patient-centered care does not begin and end a doctor’s office. Healthcare information and education should be widely available to all Americans before sickness occurs.   This information and education helps patients and their patient advocates make informed decisions in all aspects of health care (e.g., in selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments). This information should be complete, easily accessible, written for the patient, and timely.

 5. Cost Effective and Affordable Care

Yes, quality of care has a dollar component. Health care costs money and the money must come from somewhere. The healthcare industry needs to understand that Americans are not an endless source of money.  The cost effective dollar component of quality is in the control of healthcare businesses across the United States. In our fragmented collection of private healthcare businesses, cost effective care is a major problem. Services and products that deliver little benefit but may be very profitable to healthcare business need to be eliminated. The lowest cost treatment or product for a given condition or disease should be identified and used. Over-treatment and over-testing needs to be eliminated. Healthcare provider businesses and hospitals that are not managed for cost effective operation should be severely penalized or even replaced with those that do.

Unaffordable healthcare affects every American. For the individual who can afford the high cost of quality care, the burden of national health spending is far too high and growing. For the individuals who cannot afford the high cost of quality care, high prices limit access to needed and high quality care. In the United States, money buys better health care for those who can afford it. The “best” medical practitioners providing the “best” healthcare are not available to most Americans.

6. Equitable Care

Access to quality healthcare must be available to all Americans in all communities and as such is a community (local and national) issue.  Our local, state, and national governments need to come together to address the need for the best healthcare quality for all residents. Groups within communities who are not receiving quality healthcare must be identified and solutions found to remedy the situation. The federal government needs to define standards for healthcare quality and community resources and leadership must be tapped for it to become a reality to all Americans.

The Bottom Line

The delivery of the best healthcare quality is about providing effective and safe care that is coordinated and patient-centered .  In addition, high quality of care must be delivered with cost efficiency and affordability. It must be equitable and not available just to the wealthiest or those in certain geographic locations.

Our system  encourages healthcare underuse (for those who do not pay enough), and overuse (for those who can).  Our system of Individual, private healthcare businesses (with its conflicting financial interests) makes full coordination of care for the benefit of patients impossible.  The concept of patient-centered care looks great in government reports but rarely practiced today in healthcare offices and facilities across our country.  Universal effective care will never become a reality for all Americans until healthcare professionals are required to follow best practices guidelines based on the newest evidence-based clinical data.   Healthcare businesses that are not managed for well-defined, cost effective operation should be severely penalized or even replaced with those that do.

Our government has only started looking to improve healthcare quality and value in a major way since 2010 (Obamacare (PPACA) reforms).  This is a tall order for a country where the healthcare system is built around money and the financial needs of those who deliver rather than receive health care.  The best healthcare quality will reach all Americans only when the primary mission of our government healthcare policy puts the welfare of patients and taxpayers ahead of individual private healthcare businesses.


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