Care Not Meeting Expectations – Where do the expectations come from?

The “Sick in America Poll” shows 45% believe the quality of healthcare is a very serious problem.   Quality is always based on a comparison with “something else”.  In the past it was difficult to compare health care with “something else”.  But now, a patient can look on the Internet for a world of comparisons (where health care does not look so good).  Or the patient will just ask a relative.

Quality is sometimes undercut by the providers themselves.  Rather than just say “an annual blood count is not supported by medical evidence”  too many doctors just say “insurance won’t pay for it.”   Rather than say “eating too soon after surgery may cause nausea”, too many nurses say “the doctor won’t let you eat.”  Rather than say “it is usually a safe drug but watch out for a rash” the pharmacist says nothing and passes out a huge list of side effects.  Where is the teamwork?  It is a set up for failure and poor satisfaction.

An academic view of quality health care is provided by the Institute of Medicine (a government organization).   They have defined six attributes of health care quality:

  1. Safe: Avoiding preventable injuries, reducing medical errors
  2. Effective: Providing services based on scientific knowledge (clinical guidelines)
  3. Patient centered: Care that is respectful and responsive to individuals
  4. Efficient:  Avoiding wasting time and other resources
  5. Timely:  Reducing wait times, improving the practice flow
  6. Equitable:  Consistent care regardless of patient characteristics and demographics


The Institute of Medicine is concerned with finding that “something” for the quality comparison.   Unfortunately, the Institute of Medicine did not list system assets such as “reasonable cost” or “sound  management” or “continuous improvement” or “reliable care” or “high national ranking”.   The goal is good, the means to the goal is lacking.  An old business saying is “measure to manage.”  Americans need to know how the health care system is being managed, at the speed of the stock market, not at the speed of academic reports.  We need to see the ticker tape for cost and quality.  If the system is not being managed well then get a new manager.

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