QUALITY

I tackled some big concepts this week. Can a DECISION FOCUS reset our approach to health care services to align what we do with what we want? When almost everything we rely on for decision-making is UNCERTAIN to some degree and there is little we know FOR SURE how can this be done in the “right” way?

The word that could be used most often to express that we get what we want and that we expect the system to provide what we want is QUALITY.

What is QUALITY in health care? Is it whether specific interventions were performed or not in specific circumstances? Is it whether or not the decisions made align with the values and preferences of the individual? Is it whether or not specific events occur (with respect to events that can be influenced but not controlled)?

I think the answer to all of these questions is “sometimes” or “it depends”. Take any one of these approaches to defining, measuring or reporting QUALITY and it is appropriate in some situations and inappropriate (being misleading or harmful) in other situations.

Sometimes we really need to FOCUS on the QUALITY of what is produced, i.e. how it is done. Inspect the strength of materials used in providing structural support if the structure is expected to bear weight and failure of weight-bearing would be catastrophic.

QUALITY of evidence is a representation of how well the methods and findings support the conclusions derived from the evidence. We are getting better every year about making QUALITY assessment more objective, more clear, more transparent, more reproducible.

But sometimes we need to FOCUS on the QUALITY of delivery, i.e. how it received and perceived.

QUALITY in a service or product is not what you put into it. It is what the customer gets out of it. –Peter Drucker