So you think your health system is bad? There are countries where doctors and nurses leave due to the risk of death (their own), countries where health care workers can’t make enough money to pay for their own hospital care, countries that don’t keep medical records, countries where doctors must see at least 100 patients per day and countries where a patient purchases the number of questions they want a doctor to ask — one question is typical — and at very low cost!
As the author of this blog I decided to try an online learning course from edX titled “Improving Global Health: Focusing on Quality and Safety” presented by faculty at Harvard. Overall it is a good course. I am sure everybody who takes the course finds different parts interesting depending on where they live and their background in health care quality and system organization.
Below are the things I found interesting from a US healthcare perspective:
- Errors and harm caused by health, especially in hospitals, is high everywhere. The big categories are hospital acquired infections, adverse drug events, falls with injury, surgical complications, pressure ulcers and deep venous thrombosis. Significant harm happens in about 10 to 15% of hospitalizations. Errors in medical/surgical management are considered preventable.
- Countries have different standards of care. And, countries have different legal systems. The most interesting concept is to eliminate malpractice suits by having a compensation board and strong quality improvement. Thus, patients get compensation much faster and the health care system improves to mitigate errors. Accountability for errors becomes part of the quality improvement process, not the legal system.
- In most countries hospital and outpatient care seem to be in different silos, much to the detriment of patients who transition between the two.
- The PLAN-DO-STUDY-ACT cycle is critical to quality improvement.
- “If you can’t measure it, you can’t improve it“. But, high tech and computerized methods are not always needed. In low and middle income countries the use of simulated patients (in the US called secret shoppers) and text messaging questions by cell phone can collect hugely important data with a minimum of cost.
- Management practices of business in general are more effective than the business practices in healthcare. The same principals apply and need to be followed. For example, managers not meeting expectations need to be changed. Just like measurements of healthcare quality there are measurements of business quality. A culture of blame is a big problem.
- Patient-centered care is critically important. There is a very strong statistical link between patients who feel their needs are being met and almost all other technical measures of quality. Simply asking patients what they expect is a huge first step that is not being done my a majority of providers. Dignity, respect and putting effort into meeting expectations is the essence of patient-centered care. One measurement of patient-centered care is waiting time — waiting time for making an appointment, waiting time in an office, and waiting for surgery.
- Universal healthcare is highly desirable and some countries do a better job than others. The key features are: enrollment (signing up and getting a health card), universal coverage (the funds to pay for care — like insurance), and finally effective application of the coverage. The last element is actually “quality” healthcare. Having a health card is not enough. Having insurance is not enough. Effective care is a combination of prevention (population-centered) and patient-centered care within the financial constraints of a system.
- Politics is present in all forms of health care. But, the focus for patients, providers and the news media should be on the gap between care that is reasonably possible and care that is actually delivered.