Dare to Care

Abstract:Since healthcare is now the third largest group in the Standard & Poor 500, it is important to assure that resources are being efficiently allocated. Two separate entities constitute quality in healthcare – quality of care, which is the objective measure of outcome, and quality of service as perceived by the patient. Both factors are important and have significant economic consequences, but quality of care is the more important the two and should shape the meaning of quality in healthcare. A healthcare system must create incentives for hospitals to invest in quality of care, while patients could compensate hospitals for incremental expenditures related to quality of service. The goal would be not to reduce quality of service for patients, but to realign incentives for …

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What a timely article this was for me! I became a victim of the dilemma of healthcare following a January 2009 surgical procedure.

After reading Dr Godyn's article, I believe the Quality of Service I received was excellent as subjectively evidenced by staff friendliness, my clean room, my comfortable bed, and the tasty meals. But, as my standard three-day stay was extended to enable being fitted with an Ankle-Foot Orthosis, it became apparent there was an adverse outcome. Quality of Care was mysteriously nowhere to be found.

I'm fortunate to be a CQE that performs root cause analysis and frequent customer complaint investigations, because I've spent the last six months slowly and methodically investigating what exactly happened during my surgical procedure to cause the adverse outcome. I'm still astounded that my surgeon thought so little of me as a patient that he couldn't take the responsibility to honestly disclose the cause.

I agree with Mickey C's comment in regards to measuring the Quality of Care by comparing the actual outcome to the planned outcome. For my situation, there is a tremendous gap!
--Lolly Kirkwood, 07-21-2009

This article is very informative and insightful in terms of identifying the two types of quality in a hospital: quality of care, which is measurable in terms of tracking the standard of care delivered to patients (for examples, care plans), and quality of service, which is based on the customer or patient perception (for example, the attitude of the staff and the food given to patients).

The two types of care cannot be separated and should be aligned to improve the overall quality of care delivered to customers or patients.
--Gerren Collymore, 07-16-2009

Great article to show the dilemma of quality in the service industry.

"Quality of Care" builds the base value. "Quality of service" attracts more revenue. Though they are not contradicting, it is difficult to have both merits at individual businesses. It is the responsibility of the organization to balance both, and establishing metrics for both would be helpful. However, different organizations would have different targets depending on the target segments of customer.
--Kyle Huang, 07-14-2009

Dr. Godyn has a lot of good points that I agree with. One of the things I have pushed, but with little success, is to measure quality of care by monitoring the actual outcome(s) as compared to the planned outcome(s). Doing this minimizes one concern he mentions: "The results of the treatment would be compared to a benchmark to judge quality of care. The relative results of the treatment would form a quality score ... However, quantitative measurement of medical outcomes is difficult. As a result, hospitals and overseeing institutions also tend to focus on compliance with processes that are believed to instead lead to higher quality of care ... This model shares the first model's weakness: The comparison of best evidence-based practices requires two medical cases to be extremely similar. Unfortunately, the multidimensionality of the problem confounds comparability."

I agree with his statements and offer the measure of what was planned for outcomes compared to what actually happened. This should adjust for patient demographics, directly comparing to 'best practice' protocols, and the difficulty of measuring the quality of care directly.

I would also suggest that a performance index of several measures be used, and this index would be the results of looking at a number of things and then putting weights to them to account for relative importance. These measures could be mostly for quality of care but add in a quality of service, too. Food for thought.
--Mickey Christensen, 07-13-2009

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