Lord Darzi announced his proposals for changes in the NHS in England today. One of the points particularly grabbed my attention – the emphasis on the quality of health care. About time I reckon. We’re still in the midst of a target driven quantities focused health service. Too much emphasis on markers set by managers rather than patients. But hang on, I thought, it’s all very well to talk about quality but what will it actually mean? How do they intend to assess and monitor quality in health care? Couldn’t find the detail in any of the news reports so I went to the Department of Health site and downloaded the full report.
What I found about quality surprised me. I am impressed! They intend to assess three areas of healthcare quality –
1. Patient Safety. I’m glad to see this in the pole position. “First do no harm” is a centuries old piece of medical advice. Too often ignored I feel. They will assess cleanliness of health care environments, errors in prescribing and rates of healthcare associated infections. I’d like to see them add something about ADRs (Adverse Drug Reactions) and rates of surgical complications. Maybe that’ll come some time.
2. Patient Experience. Compassion, dignity and respect are to be assessed by questionnaires. There are other aspects which could be assessed (patient empowerment for example) but this is a good start.
3. Effectiveness of Care. This is the MOST interesting area. Not only will “clinical measures” be considered, but, very importantly, “patient measures”. Here’s the buzz acronym – PROMs – it stands for “Patient Reported Outcome Measures”. This is a great improvement. I know, you might find this amazing. The BIG breakthrough here is to ask patients not only what has been their experience of healthcare but what outcomes really matter to them.
Are there any particular elements of “quality” in health care do you think should be considered?
Heroes Not Zombies 
Doc,
I don’t know if my comments will in fact be welcomed. I had really lousy experiences with the NHS.
I think they NEED to sort out border issues as one huge thing. A friend of mine slipped through the cracks between Berks and Bucks when he needed SERIOUS psychiatric care. It was absolutely appalling. Another friend of mine is in the same position with treating of OCD. Ridiculous!
I think they NEED to stop trying to reinvent the wheel and stick with one program and make it work rather than an entire hodge podge of systems that they currently seem to employ.
I think that they NEED to update the equipment, communication methods, and test results procedures to make it easier for both Dr. and Patient to be supported efficiently.
I think that the mystique of Doctor’s, Surgeons and Matrons needs to be done and over with. They put on their pants one leg at a time like you and me. None are God, none are above question or reproach.
I think they need to stop being so knee jerk reactionary when they have an issue and for God’s sake stop all of the lengthy public enquiries. It wastes time and money that could be used on people to get well.
I think that meds should be universally accessible around the country. There shouldn’t be shortage of service to cancer patients.
I think that the ability to “go private” takes away from the idea of a nationalized health care system. One rule for the rich… to hell with everyone else. They aren’t as worthy.
I think that Health insurance in the UK is the biggest scam I have ever seen in my life. Not only do you pay equal amounts to what an American would £ to $, but you get far less service, and then they limit the amount of treatment you are allowed to have! OCD doesn’t go away does it?????? Sheesh
Sorry if I am having a rant… Im just saying that there is a bigger picture that the government isn’t addressing at all.
Don’t apologise Amber. Thank you for your rant!
Seriously, I’m sure you’re not alone with many of these thoughts. I agree there’s a far greater picture not being addressed – and, for me, it’s that there is no clear idea of what “health” actually is, so how do you create a “health service”, when you actually only know what “disease” is – I know, I know, it’s been said many times before but we have a National Disease Service more than a National Health Service – and it falls down because disease, especially chronic disease, cannot be satisfactorily addressed without understanding, stimulating and supporting healing. I’m hoping we will begin to move towards a greater understanding of health, healing and how we attain them. Alongside that I happen to think THE most important factor in health care is PEOPLE – the patients and the therapists/carers. Oops….getting carried away here – that’ll be the subject of another post I reckon.
Thanks again anyway Amber
Hi Bob,
Like you, I was simultaneously amazed and delighted to see such an emphasis on quality and patient outcomes in the report, although I would have liked to see more on the quality of the intervention itself, paricularly with reference to the medicine and the practitioner. I also thought it was a little light on the need for ongoing structured (multidisciplinary?) education.
Overall though, it’s a start – it may finally begin to drag NHS England away from focussing on the drugs and the £££s towards the more patient-centred Scottish approach. The latter is of course by no means perfect but it’s structure and foci are perhaps more aligned with the needs of a progressive, modern healthcare system and the patients it is supposed to serve.
These are admiral goals. In working with clients in the US, I have found that many health systems have trouble achieving this goal because they are significantly underinvested in quality management Infrastructure, Process, and Organization. The objective is not to cram for, and get a “passing” grade on the triennial Survey, it is to develop a “world class” quality management foundation that includes:
Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a Board-driven imperative to achieve quality goals.
Infrastructure: incorporating effective quality management technology, EMR and physician order entry, evidence based care development tools and methodologies, and quality performance metrics and monitoring technology that enables “real time” information.
Process: including concurrent intervention, the ability to identify key quality performance “gaps,” and performance improvement tools and methodologies to effectively eliminate quality issues.
Organization: providing sufficient number and quality of human resources to deliver quality planning and management leadership, adequate informatics management, effective evidence based care and physician order set development, performance improvement activity, and accredition planning to stay “survey ready every day.”
Culture: where a passion for quality and patient safety is embedded throughout the delivery system and leaders are incented to achieve aggressive quality improvement goals.
My firm has assisted a number of progressive health systems to achieve such a foundation, and to develop truly World Class Quality. Feel free to visit my website to see more about this and about innovative quality measurement systems.