Quality health care?

You work in a conventional commercial organisation and have some involvement with quality - whether defined by compliance (ISO) or performance. You can answer the 'what is quality' question. Can't you!?

But what about not-for-profit organisations? Schools, hospitals, volunteer fire brigades, ambulance services … . How do they answer the 'what is quality' question? Increasingly, they are being required to do so, and not finding it easy (for some work on quality in education, go to www.baldrigeplus.com and down-load the Hospital Preschool paper at the page).

My current interests are in local government and health. Health … now there's a minefield! How do you define health care quality?

Here in New Zealand all of the key players (and especially the regional and city hospitals) will have to be accredited soon. That's a compliance, or systems, approach - the equivalent of ISO 900X.

What about quality as performance excellence - the 'Baldrige' customer and process-focused approach? Not as easy; more likely to be relevant to 'customers' and to affect user experiences; more resource-intensive. Much more likely to result in organisational transformation.

What would a performance-based approach to quality in a health service look like? One answer is provided by The National Committee for Quality Assurance (NCQA), a private, non-profit organisation dedicated to improving health care quality in the USA. NCQA has been reviewing American health care organisations since 1990, and it rates providers in five sub-categories:

1. Staying healthy
Does the service help people maintain good health and avoid illness? Is a full spectrum of preventive care (screenings, check-ups) covered? Are there proactive immunisation programmes? NCQA reviews health plan records, grades independently verified clinical data and reviews materials sent to patients.

2. Getting better
How well are people cared for when they become sick? How are new medical procedures, drugs and devices assessed to make sure that patients receive safe and effective care? NCQA reviews health plan records and interviews staff.

3. Living with illness
How well does the service help people manage chronic illnesses? For example: Are there programmes to assist patients manage conditions like asthma? Do diabetics - at risk for blindness - receive eye exams as needed? NCQA grades independently verified clinical data and interviews staff.

4. Qualifications and expertise
Are the credentials of all providers checked and verified? How satisfied are members with general and specialty care? How well do caregivers communicate with patients and their families? To evaluate these activities, NCQA uses records of doctors' credentials, interviews staff and grades the results from consumer surveys.

5. Access and service
Do patients have access to the care and service they need? Are grievances resolved quickly and fairly? How quickly can patients get appointments? NCQA reviews appeals and waiting time records, interviews staff and grades the results from consumer surveys.

Surprise, surprise - NCQA has discovered that higher rated providers in the USA outperform non-accredited providers in all measures of clinical care and patient satisfaction, and typically show continuous improvements in quality from year to year.

What's the lesson for New Zealand? Compliance to standards (accreditation) is an important first step, just as it is in commercial organisations. But quality that matters; quality that is seen and felt by real users, is performance-focused, and goes far beyond compliance.

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