The health consumer gets it, Lord Darzi gets it and framed an entire review around it, Sir Bruce Keogh certainly got it during his time as president of the Cardiothoracic Society, and the outgoing chief medical officer has dedicated a working lifetime to it.
The Care Quality Commission would like to get it providing it can find a way to organise it. Nobody is really sure about Monitor’s role in it, and the Department of Health comes up with a different answer to it about every six months.
It is time we reset patient power. How bad does it have to be before PCTs ask for their money back
Until world class commissioning, primary care trusts and insurers never really procured in reference to it. The unions and royal colleges manage to stay rather silent about it when it goes wrong. Dr Foster loves to talk about it, and the NHS Information Centre has an awful lot that would probably solve it.
So what are we talking about? How to define quality in healthcare.
This is probably the most important and difficult question there is within the NHS and clearly means different things to different people.
Everyone is always for quality and I have never had a patient ask me if I could recommend an average specialist in a Nuffield Hospital. And this is the problem. After nearly 2,500 years of medicine and after 60 years of the NHS, no one has an accepted definition or framework for the quality of patient care.
I have a friend who used to run six television factories in Eastern Europe simultaneously from Glasgow. To him, quality was simply a measure or state of being free from defects. Executive teams look more closely at the quality differentiation and specification of services. An economist would look not at what the product or service is, but what the consumer or patient gets out.
Ultimately it must be the patient’s view that is right. We have all taken back goods, switched manufacturers, sought refunds or demanded compensation in other areas of our lives. It is time we reset patient power. How bad does it have to be before PCTs ask for their money back?
We are moving towards an era of quality accounts, at a time of political change and potentially of liberalised and elevated regulatory standards. Those buying healthcare must put themselves in the patient’s shoes. The system is further confused by the regulator disempowering the purchaser - the ultimate sanction in any market is the consumer (or those acting on their behalf) withdrawing their custom.
So what should the formula for compiling this quality information look like?
The final formula doesn’t really matter providing it is clearly defined across the system in terms of definition, measures, units and timeframes and that it gets published openly in the public domain to allow benchmarking and comparison.
It probably doesn’t really matter whether the data is perfect or if we account for the, “my hospital is special”, argument. We would all move like greased lightning if the top 1,500 good hospital, community care and GP guide was written across the system to this pattern.
But not wanting to sit on the fence here are my top seven criteria:
- Clinical variances: mortality, healthcare associated infections, returns to theatre, readmissions and the like.
- Range of services.
- Patient experience measure by satisfaction, recommendation and complaints as a percentage of activity.
- Incidents by theme, mandatory indicators and serious untoward incidents.
- Independent audit of key service lines.
- Percentage of eligible trained staff completing training in each area of risk management.
- Outcomes in terms of survival and patient reported outcome measures.
The quality account introduction states this is all about leadership, organisational accountability, openness, transparency and quality improvement.
It is often argued that patients don’t make choices on quality but I believe health consumers are ready to seek answers to the question: “Is that clinician any good at my condition?”
Aristotle is quoted as saying that quality is not an act, but a habit. Some philosophers would argue that quality cannot be defined, but my belief is that as clinicians it is time we helped the politicians out with an objective definition. Information, information and information would be my recommended mantra for the next health secretary.