The “quality of healthcare” vs. the “quality of mercy”.
A recent article in the Boston Globe highlights the very human dimension of errors in healthcare. W. Edwards Deming said that “quality” is the degree to which a product (or a service) is free of controllable defects. This is an excellent definition in so many respects. In healthcare, many “defects” (errors) are controllable, while many others are not. Medical and healthcare services are fraught with too many mitigating factors, too many permutations and combinations of variables. We must, however, continue to try to measure and control. The quality of mercy describes the degree to which the injured will go to forgive and move on. This is extraordinarily difficult, but as we all have witnessed in our lives and others’, not impossible. We must try to expand our tolerance for error, by accepting the human-ness of the pursuit. I thank Dr. Manisha Juthani-Mehta for this thoughtful piece.
In a vigorous exchange on this subject, an attorney suggested that financial penalties were the best, if not the only recourse for individuals who have suffered harm in the hands of doctors and other providers. And a quality control/systems expert suggested that the real issue. Our systems errors, and that healthcare has not been rigorous involving W Edwards Deming’s principles.
Regarding financial penalties, the current system of medical malpractice action perpetuates a dominant “perpetrator versus victim” model operating within the culture and in the medical malpractice environment. This strong cultural orientation stems from the deep-seated assumption that healthcare providers have the answers and doctors as the captains of the healthcare system are either correct or culpable. On the face of it, this is absurd. In practice, especially here in the United States, we wind up with preposterous medical malpractice regulations and premiums, states like Florida where physicians decide to go “bare”, and juries awarding damages which go far beyond any actuarial rationale. If Deming is correct, and only 6% of errors are due to “strong undesirable behavior”. We should strive for a system that protects individuals from those egregious instances, and allows providers to stop practicing defensive medicine, and encourages consumers to accept that physicians, nurses and others are human, and practicing clinical care is much more complex than Web M.D., might lead you to believe. We need reform in this system.
What attracted me to the narrative of the story by Dr. Manisha Juthani-Mehta was the juxtaposition of the “quality” of healthcare, and the “quality” of forgiveness. Both must be nurtured. Is this unrealistic?
Managing principal of non-profit management consulting firm, with an emphasis on strategic planning and development.
9 年Excellent read, always spot in Irving Stackpole!