In life we want things to be of high quality, and we don’t mind paying higher than usual price for that. When it comes to our own health and the healthcare system, we should also think about quality and as a physician provide it to our patients, or as a patient demand quality from our physicians.
How do we define quality in healthcare, as everyone has their own concept of quality based upon their experience and expectations. The institute of medicine, USA gave the definition of quality as:
“Degree to which healthcare services for individuals and population increase the likelihood of desired outcomes and consistent with current medial knowledge.”
Healthcare is very dynamic area and defining quality is not easy. That is why people have different ideas regarding quality. Since quality depends upon factors such as physician expertise, resources, disease burden and other factors it is always a challenge to maintain quality especially in low resource countries like Pakistan.
People who study quality issues have observed that even in the well developed healthcare systems, evidence has shown that quality still remains a serious concern with expected outcomes not particularly achieved and with wide variation in standard of care.
They also see that the process of improvement of quality has to be based upon the local dynamics and local strategies of quality so that the best possible results are achieved from new investments into the system.
The above phenomenon shows the fact that mere increased know-how and increased infrastructure does not translate into high quality of healthcare which the individual and the population masses rightly demand.
Measuring the quality is very important as we discussed early and by a yardstick that can easily be measured. So the quality usually is measured in terms of achieving desired outcome or goals. These goals can be summarized as:
- Reducing mortality.
- Reducing morbidity.
- Reducing healthcare inequalities.
- Improving outcome of a particular disease.
- Making healthcare safe.
How on ground we can achieve this goal depends upon where we deliver the healthcare. In urban areas of Pakistan, it may mean optimizing the process of healthcare delivery as there is significant infrastructure as well as fair number of physicians providing the healthcare, but in rural areas or along the outskirts of the big cities the problem is many folds and improvement in infrastructure as well as trained individuals are both needed.
Any one can easy realize that the key obstacle to the improvement and attaining of the high quality in Pakistan is :
- Lack of sufficient financial investment.
- Fragmentation of delivery of healthcare services.
- Poor quality of care.
Let us see how in theory the quality of care can be raised in these areas of Pakistan. This theory is well summarized in the WHO report on quality for the low resource countries. The healthcare system should seek to make improvement in six areas or dimensions of quality and so after these improvement the healthcare system should be:
- Effective
Delivering healthcare should be based on evidence and results should show improved outcome for individuals and communities, based on need.
- Efficient
The healthcare system should work by maximizing resources and avoiding waste.
- Accessible
The system should be timely, and geographically reasonable, with right balance between the available skills and resources to serve the needs of the community at hand.
- Acceptable/Patient centered
The healthcare system should be consistent with the social norms and individual patients aspirations.
- Equitable
The healthcare system should maintain the quality regardless of personal characteristics such as race, gender, ethnicity, geographic location and socioeconomic status.
- Safe
Healthcare system should work to minimizing risks and harm to the service users.
By now it is evident that the delivery of high quality care is a combined effort and requires the participation of all the sectors and people affected by it. The most important roles have to be played by the communities, physicians and the local and national Governments, besides the policy makers. So the people should work together to bring the quality up and continuously work to improve it. The human capital should be developed as well as investment should be made carefully in bring the infrastructure that complements the human capital.
We should do an assessment of the situation and then plan that is based upon our needs, resources and norms of the country. Once we establish the system at any level, we need to do our audits and based upon these audits carefully build the second cycle of improvement. This is how the world has achieved the high standard and that’s how we also can deliver.
I can be reached at ERDOC@shifa.com.pk