How do you measure quality? Even though good or high quality is important, how each one of us measures “it” can be quite different.
Having some measure of quality is important because it can be the basis on which we evaluate many things. Often it might be why we choose one thing over another, or why we make a particular recommendation. And, having commonly agreed upon standards of quality provides a vehicle for groups of all kinds to make collective decisions.
Quality in health care is certainly important. It has been discussed in great detail for many years. Millions of dollars have been expended on research in pursuit of a standard that is felt to be “better” or “improved” – thus, implying better quality. The debate around better quality in health care has been especially focused since the Affordable Care Act has become law. Yet, “measures” of quality for health care remain elusive and not universally defined.
How do we achieve high quality in health care?
Perhaps a bit of history can help us answer this question.
Quality assurance or quality control in business and industry became highly refined and perfected after World War II by W. Edwards Deming, an American statistician, professor, author, lecturer and consultant. He taught Japanese industry how to apply statistical methods towards manufacturing standards which led to Japan becoming a world leader in quality products.
As a result of Deming’s work and its profound impact on industry and business, the Deming Institute was started to assist business and industry to apply these highly effective principles and techniques in other countries.
Though not based on Deming’s work, another organization, the National Association of Healthcare Quality was formed for the same purpose in the health care field – improving and assuring quality in the delivery of health care services. Areas where the Association works to make improvements, to name a few, are:
- mortality and incident rate reduction
- risk management
- core measures
- patient safety
- quality management
- quality improvement
But are we always approaching improvements in health care in the right way? Sometimes our efforts to make things better actually have the opposite result.
Dr. H. Gilbert Welch, MD makes this point in his book Over-diagnosed – Making People Sick in the Pursuit of Health. Welch looks at how our pursuit of health, with the aid of improved technologies, has resulted in new standards for what is considered “sick”. Unfortunately the newly defined abnormalities are being treated unnecessarily, resulting in consequences worse than the condition that was treated.
…we are in the midst of an epidemic of diagnosis. [T]he conventional wisdom tells us that this is good: finding problems early saves lives because we have the opportunity to fix small problems before they become big ones.” (pp. 9-10)
But “… more diagnosis leads to excessive treatment—treatment for problems that either aren’t that bothersome or aren’t bothersome at all. Excessive treatment, of course, can really hurt you. Excessive diagnosis may lead to treatment that is worse than the disease.” (p. 11)
Aside from the detrimental physical effects of over-diagnosis and thus over-treatment, there’s the monetary cost of treating what doesn’t need to be treated. And worse yet is the anxiety and fear that is created when we start to call what was once normal, an abnormality or sickness. The resultant stress can actually create or exacerbate ill health.
All in the pursuit of quality health care. Aside from a trend towards over-diagnosis and over-treatment, we shouldn’t forget, however, that advances in medicine have been tremendous.
Often left out of the examination of quality in health care, however, are the less tangible measures of things such as does the care include treating the person as a whole person? This includes recognizing the impact on the patient of the environment around him/her, how he/she is treated by the physicians, nurses and other staff as well as respecting and incorporating the patient’s spirituality in the treatment plan.
Research is increasingly showing that our thinking, including our spiritual beliefs and practices, can have a significant impact on our health.
… spirituality can positively influence immune, cardiovascular (heart and blood vessels), hormonal, and nervous systems.
“[H]ealth benefits of religion and spirituality do not stem solely from healthy lifestyles. Many researchers believe that certain beliefs, attitudes, and practices associated with being a spiritual person influence health.
One clinical study at Duke University found that people who attend regular religious services tend to have better immune function. In another clinical study of 232 older adults undergoing heart surgery, those who were religious were 3 times less likely to die within the 6 months after surgery than those who were not.”
Quality in conventional medicine is a must. And, more and more people agree that quality care happens when patients are treated as whole persons in all dimensions, including physical, emotional and spiritual aspects of being.
Spiritual activist and health writer Mary Baker Eddy comments in her book Science and Health that:
The calm, strong currents of true spirituality, the manifestations of which are health … must deepen human experience…”. (p. 99)
The human experience can certainly be deepened in the pursuit of excellence in any field, but especially in health care.
We can all celebrate the value of quality and excellence in health care, especially when its achieved through seeing and treating the patient as a whole person.