When we talk quality in healthcare, what are we really talking about? We’re talking about the quality of care received by the patient from their clinician. Not just the procedures done, the tests ordered or the drugs prescribed, but the quality of the information given to the patient and the clinician’s ability to engage and empower the patient to utilize that information to take better care of themselves.
Everyone should read Kristen Gerencher’s article in the WSJ online, Imagine Doctors, Patients Talking.
She makes a number of good points, not the least of which is that when a doctor and patient build a therapeutic partnership based on “mutual honesty and transparency” the patient will often choose less expensive care options. This is because they trust the doctor to tell them, honestly, if they don’t really need the most expensive test or procedure. This trust will also facilitate the patient feeling accountable for complying with the doctor’s instructions on taking care of themselves. They want the doctor to trust them, too.
As a former state and federal prosecutor, credibility is an issue I’ve examined, and cross- examined, up close and personal. If we really want credible measurement of healthcare quality and efficiency we need to move beyond self reported clinical data. We need third party collected, patient reported data from as close in time to the clinical interaction as possible.
In a 2008 National Business group on Health report, Transparency: Large Employers’ Perspective, the NBGOH indicates that in a survey of 120 employers, 56% of whom had more than 20,000 employees, one of the key findings was that employers should “continue efforts to build credibility of quality and efficiency measurement”. Indeed they should.
How can this credibility be hard wired into the quality measurement system?
By having a third party collect it, directly from the patient, immediately after the clinical interaction. By collecting the data through easy to use and understand health information technology so that the patient is empowered to participate directly in measuring and improving the quality of their care. By utilizing technology to build “mutual honesty and transparency”, thereby strengthening the therapeutic partnership between the patient and caregiver.
If we want credibility, if we want patients to trust their caregivers, if we want the billions of dollars of funds coming into healthcare for HIT to lead to better outcomes – if we want to really understand what is happening when a patient sees their caregiver, so that we can continually improve the quality of that interaction– all we need to do is give the patient a voice.
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