What is quality?

4

Category : Medical Rants

Last week, SGIM sponsored a Quality Summit. During this 1 day meeting we focused our discussions on performance measurement and how should adjust for multiple co-morbidities. As the President of SGIM, I organized this conference and greatly enjoyed the intellectual stimulation during the presentations and the discussions that followed.

However, as I have reflected on that conference I feel like the blind man examining an elephant. Which part of the elephant did we examine?

What are the attributes of high quality medical care? I am giving my opinion on this subject later this month at a conference and had to put my thoughts into Powerpoint slides. My current formulation has at least 4 explicit dimensions:

  • Diagnostic acumen
  • Patient interactions (Careful explanations; Motivating patients (behavior change or adherence); Understanding the patient’s motivation)
  • Management
  • Interactions (Understanding how drugs interact; Understanding how diseases interact)

We currently spend our energies focused on management and screening, because those dimensions are tractable for measurement. I worry that focusing our energies on measurement will detract from the other important characteristics of excellence. Afterall, physicians do know how to do well on the test. We all want excellent physician quality. We must be careful that we do not become enamored with what we can measure as an indicator of overall quality. Being a physician is much more complex than filling out check lists. Being a critic of current P4P does not mean that I am a critic of quality.

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Comments (4)

I would include some risk adjusted measure of successful outcomes vs complications, infections, even deaths if we are talking about surgical procedures.

Robert M. Pirsig discusses at length what “quality” means in Zen and the Art of Motorcycle Maintenance; it’s a good read that adds a philosophical view of quality that may benefit your examination of “quality.”

I just posted (here) on my experiences with a P4P discussion at a recent medical meeting. The whole issue of “quality” and how it is defined is my main point.

I posted a counter-rant Here

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