What's your view on healthcare quality?

                Healthcare quality is often defined by which party is affected by the term.  A patient’s perception of quality is defined by different standards than the provider and the payer of the service.  Each party’s perception is their reality. The same health care encounter can be understood to have taken place in three different ways.

                A patient defines quality based on different factors such as the amount of time it takes to complete their service. Quality care is provided in a reasonable period. Outstanding waiting times take away from the entire patient experience and the “quality grade” for the encounter begins to drop. Many patients will base quality of care based on the amenities the health organization has to offer. Typically, patients will not understand, medically, the extent of their encounter and rely on other factors to determine the quality of their care. Hospitals who are able to offer hotel-like amenities are perceived to have high quality care to an extent.  Simple organizations may suffer from being labeled as not providing outstanding care.  Patients value awesome customer service and patient centered care. Patients want to feel as if they are the most important piece of the equation. Anything that will make them anything less, again, will lower their “quality grade”.

                A provider may view quality based on the actual care provided. The provider does understand the importance of customer service and providing patient-centered care, however, the most important aspect of care is the actual medical attention given. Providers want to know if their service was successful. Was what was intended to happen the result of the encounter? Was there an adverse reaction? Is the patient better or worse? These are some of the questions providers will begin to ask to determine the quality of care for that specific service or encounter.  Providers will also need to be conscious of regulation compliance. Healthcare is a highly regulated field for different accreditation bodies, legislations, and requirements for the government. Providers will constantly need to ensure that they are in compliance or their entire operations may be deemed as low quality or no quality.

                Lastly, the payers may have their view on what quality. The patient may look at their personal experience, and the provider may also look at a one to one basis, but the payer (insurance companies) can look at numbers. The payer are more statistical, for lack of better words. Is the health organization providing satisfactory numbers with their health encounters. Are they remaining within the specified parameters of the company in order to receive payments. The payers may be less concerned with patient-centered focus of health care and more concerned with the numbers and the money, hence they are categorized as the payers.

Quality is perceived differently depending on which view you decide to take on. 

Patient’s Perspective: Adverse Events

             The text describes patient safety as freedom from accidental injury. The patient is the center of the healthcare experience. Providers strive to ensure the best for their patients. Providers must understand that patient’s safety is the upmost of priorities. In such a delicate field, healthcare professionals deal with the lives of people. It is up to the providers to ensure that they are free from harm, pain, injury, suffering, and the least negative experience as possible. When patients unfortunately experience harm, pain, injury and suffering from a health care encounter, that is considered to be an adverse affect. Patients, the center of healthcare, determine whether an adverse event has occurred.

                A provider will only know if an adverse event has occurred if the patient has informed him of any pain they are experiencing. Providers are unable to feel or experience what the patient experiences. They must rely on the accounts of the patients to determine if they have been adversely affected.  Sometimes if the patient is not in a position to express any pain, this may be considered a way a provider has determined the occurrence of an adverse affect. An example I have in mind is from an episode of Grey’s Anatomy. Although the story was fictitious, it is real life situation that has the possibility to occur. A patient underwent a brain procedure. The attending physician was called out of the latter part of the surgery. He allowed for his two residents to complete the surgery, which they had the capabilities to do successfully. The residents took upon themselves to remove more from the brain than that was authorized. When the patient woke up from the surgery, the residents’ unauthorized removal affected the speech of the patient. The patient was unable to speak properly, and even though they literally could not express their suffering, by being unable to communicate have confirmed an adverse event.

                 Providers may believe they are in a position to judge the occurrence of an adverse event; however, it is a very subjective topic. What one patient may perceive to be painful may be tolerated by another patient. What may be a traumatic outcome for one patient may not be for another. With such high subjectivity, it is ultimately up to the patient to inform the provider.

                The determination of adverse events is not always in clear black and white. It must be understood that some medical interventions cause harm. Chemotherapy, for example, is very difficult to endure. Although the radiation kills the cancerous cells in the body, the side effects leave the patient with characteristics of an adverse event. They experience pain, physical and emotional suffering. However, the goal of the intervention is being achieved. In this case, it is difficult to determine if the patient is experiencing an adverse event.  However, even though these side effects are known to occur, does not make the procedure acceptable as is. Scientists and researchers need to be hard at work to create treatments that will not leave the patients physically distraught. It serves as a contradiction, in order to get better in one area they must deteriorate in others. Adverse events should be used to motivate researchers to continue to improve the patient experience. 

Reference:

Ranson, E. R., Joshi, M. S., and Nash, D. B. (2011). The healthcare quality book. 2nd ed.  Chicago: Health Administration Press.

UCF Campus Care: My Personal Experience

                Thankfully, in my lifetime, I have had few personal encounters with the healthcare system as a patient.  I have not been through anything traumatic or required extensive medical care; some mishaps here and there, but nothing too serious.  I have been at UCF since Fall 2008, and many of my healthcare encounters have been through the health care providers that are on campus.

                The on-campus health center does a pretty good job with providing students with a variety of health services that address a range of needs.  The health center offers acute care, primary care, women healthcare services, dental needs, an allergic clinic, and many other common health care needs. And if they are unable to provide a service, they have a decent referral system to local providers who are to meet more complex needs. The health center is very organized, well-kept, affordable, and accessible.

                Scheduling an appointment with the specific department is never a hassle. There is always availability for the requested services and I have rarely had a schedule conflict. I am always able to find a convenient time. I consider convenience to be an “amenity” in healthcare because there is such a lack in many organizations. I live very near to campus and having a health center with such a range of services is beneficial to me and my lifestyle.

                The health center is well organized. It is not difficult to locate the department you need when you arrive. There were no long wait times and I did not repeat similar registration steps if I returned to the same apartment for a follow-up or a different reason. The facility is also operating with electronic health medical records. Therefore, each provider is able to access all my care done within the facility and be aware of any other factors that can affect any present treatment or services offered to me.

                When paying for services, it gets better. Simply put, if I do not allow the physician to put anything in me I will have a free visit. The minute I allow a test, an injection, or a procedure to be performed, I will be billed. I can use the facilities for recommendations or expert opinions when I have fallen ill. And even if I allow a service to be done for me, the charges are not as outrageous as many other places. This matters to me the most, because I unfortunately do not have health insurance. I want to be able to get the best care I can receive with a price I am willing and able to pay.

                Of all my health experiences with campus care, I have been “healed” or the problem have been resolved. They have treated me with respect and have shown genuine concern for my need. I can honestly testify that UCF has provided quality health care services.

What does quality mean to me?

                I read a quote that simplified quality to providing right care at the right time to the right patient. Although the quote is very simple, when broken down it can mean so much. The text describes the different definitions that can effectively define quality, but many of the points seem to share similarities in terms of appropriate, effective and efficient care that centers on the patient without any delays or errors.

                The first part of the quote is right care. This means that the patient is receiving appropriate care for their condition. They are given the right tests, the right procedures, and the right services. There have been horror stories where patients have had the wrong leg amputated or have been administered incorrect medication. It is the priority of the health organization to do everything within their power to completely prevent these incidents. The lives of their patients literally depend on it. Right care requires knowledgeable health care professionals of all areas; from clinical to administrative and management.  They are to know what they are doing in order to provide the best quality care. They must be up to date with research and the constant changes that health care experiences.  Providers must be able to provide efficient and effective care to their patients. They must seek to eliminate waste and be cost effective. All these factors comprise of “right care”.

                The second part of the quote is right time. Care should be provided in a timely manner and without excessive delay. This can be at the time of care or scheduling services. Long wait times are often associated with the emergency department. I personally have waited hours in the emergency room for a 10-minute encounter with a healthcare professional. That is the opposite of quality care. Many conditions cannot afford to wait that long. The same goes for scheduling of services, especially specialties. Often times, in rural areas especially, patients will have to wait as long as weeks sometimes to see a specialist.  Waiting at physician offices for over an hour is also unacceptable, especially with an appointment. Providing appropriate care with a reasonable period is paramount to quality care. Time is truly of the essence for patients with delicate conditions, and frankly, people have other things in their lives that they must attend to.

                Finally, the right patient is part of quality. Quality care should be patient centered. The whole reason the healthcare industry is existent is because of patients who are in need. Patients should be the priority of each healthcare professional and organization. Their needs and many of their wants should be met. The patients should be treated with respect. The patients should feel as if their providers are truly servicing them.

                Health care quality has so many technical components. However, for me, it is very simple. When I walk in to a health care facility, I want to feel welcomed. I want to feel as if the facility has the capability to deliver the care I need. I want to be able to research the company and find positive reviews in all areas. I do not want to wait until four when I have a three o clock appointment time. I do not want to feel like a burden or inconvenience. I want my provider to be able to answer my questions and ease any anxiety or discomfort. I want a positive health outcome. I went to the dentist today for a filling. The hygienist offered me a blanket because I looked cold and shades to protect my eyes from the light in my face. Seems very simple and trivial, but I loved it and was satisfied!