Email
In conference and in conversation, two words in common parlance are health and quality. All of us in my business like to consider that we contribute to the health of individuals and that the care we give is of high quality.
But one of the extraordinary things about these two concepts of health and quality is that there is no simple definition of either, nor is there a clear idea of how they relate. For those of us striving to provide high quality healthcare, that lack of definition, with the resultant lack of clarity, significantly impedes progress.
It gives me further pause for thought when I reflect on the cost of the armies of auditors who deluge us with data which are driven by politically generated targets. Alongside consideration of the cost of high quality healthcare, one really ought to consider the cost of the proof (if indeed it is) of such delivery.
I have a couple of suggestions. Even if they only provoke disagreement they will partly serve their purpose, as long as that disagreement is followed by debate. Firstly, we could measure health in communities, at the level of primary and secondary care, through response to the following three questions:
How well are you? (rate 0 to 10, 10 is very well and 0 is extremely unwell)
Can you walk a mile? (score 5 for yes and 10 if you have done so in the last three months)
Have you been treated in hospital in the last year? (do not count pregnancy, score 10 for no, 5 for out-patient treatment and 0 if admitted to hospital)
Score range therefore 0 to 30
To help determine quality we could make a start by asking, for one in 10 of healthcare interventions, to both the receiver and the giver of care:
Were you happy with the care you received/gave? (score 0 for very unhappy, 10 for very happy)
Score range therefore 0 to 20
I accept that this is really a measure of satisfaction, rather than in an objective assessment of quality, but isn't it noteworthy how often these two things are related?
This may seem too simplistic to be in any way worthwhile, but I believe it offers several benefits. Firstly, the pure act of measurement drives up quality. Secondly, these scores will allow crude comparison – between populations or between areas of an institution (could be a practice, could be a hospital) to identify differences.
If these suggestions have merit, it lies in their simplicity rather than any form of statistical robustness. It can, sometimes, be better to reduce the complexity of something in order to work with it, rather than be paralysed by its complexity.
Of course, it would not identify the reasons for these differences, but it could help to focus attention on problem areas and, in addition, it would allow comparison before and after intervention: for example, on admission and on discharge from hospital, then on out-patient or primary care review. Lastly, and just as importantly, this approach would not require the recruitment of another brigade of auditors or managers. This is something that we, the givers and receivers of healthcare, could do for ourselves.
So what about it? Is it worth a try? Perhaps it is, but only if we are prepared to share the scores and learn from the best and worst. This is not about winning – it is about improving. That must be worth a try.
Dr John Wilson is a consultant gastroenterologist at NHS Fife, and spoke at February's SmartHealthcare Mobile and Wireless conference
;
Comments