How do we know we are good?

The delivery of health care or in most cases the management of disease is a difficult business. Expectations of people have increased with the growth of the easy access to information on the web. This means that people no longer are less knowledgeable than their health care providers and they theoretically can always look for alternatives, writes Dr. Peter Lachman.

Dr. Peter Lachman
Dr. Peter Lachman

The reality for most is not so optimistic as most people are dependent on the services provided locally, without recourse to other opportunities. It is therefore imperative that we achieve reliable high-quality care wherever it is delivered.

Over the past decades we have had great success in medical interventions, and this has resulted in the complexity of care today. Not only are people living longer , but they have more complex diseases as a consequence.

Yet we have continued to use past designs to deliver the new demands. A result is the impact on patient safety and the increasing harm that people experience. In addition, we have not worked out how to deliver care reliably in an equitable fashion – i.e. every person receives high quality care the first time every time.

We need to do ‘what it says on the tin’ for all people not for a select few.

There are many papers on achieving high reliability in healthcare – e.g. the one in 2006 by Pronovost et al. which emphasises the need for the culture of the organisation at all levels to be focused on value based care with equitable reliability at the core . We need to do ‘what it says on the tin’ for all people not for a select few.

It is not surprising therefore that there is a degree of dissatisfaction with healthcare that is delivered. When it is good it is very good – yet the chance of a person receiving 100% reliable care continues to be low – approximately 40% of the time to achieve all six domains of quality . (Based on a 0.9 chance in each domain of quality.)

We would not accept that degree of unreliability in any other industry. Yet many people in healthcare think they are good. How do we measure what is good and what is not?

To that ends I have thought that there are a few things we can do.

Wellbeing – look after ourselves, and of our fellow workers. It is clear that if healthcare professionals have a good state of mind and are happy at work then outcomes for the people, they serve will be positive.

Person centredness -always treat the next person as if he or she were a family member – never treat people as patients with a disease, with a number and no name .

Safety is our business – consider all potential risks prospectively rather as an incident and prevent rather than react. Incorporate human factors in all we do.

Measure our performance prospectively in terms of what we expect for ourselves – and do this daily, so that one can continually improve.

Start with the next person who comes to your facility. Ask would I like to receive the care I have delivered . And then continue to the next and the next. Only then will you know whether you are good.