I recently read an article which talked about the causes of quality problems. It stated how patients suffer harm because of three different types of quality problems. The first occurs when patients do not get beneficial health services. The second happens when patients undergo treatments or procedures from which they will not benefit. The third occurs when patients receive appropriate medical services, but those services are provided badly, exposing patients to added risk of preventable complications.
Extensive research has documented that all three forms of clinical quality problems—underuse, overuse, and misuse—are ubiquitous in American medicine and deserve urgent attention.Substantial underuse of effective interventions pervades the delivery of preventive care, acute care, and chronic care; it occurs across age groups, reimbursement schemes, geographic regions, and sites of care.Studies of misuse in medicine have focused on errors made in the hospital. One subset of such errors includes those in which patients are injured as a result of negligence.Probably more important as a cause of overuse is the fact that physicians are often overly enthusiastic believers in the value of the services they provide. Over the past several decades the number of available medical and surgical interventions has increased exponentially. Because physicians derive a great deal of satisfaction from believing that they are able to do good, these newly developed interventions are commonly used in the absence of good evidence to support their efficacy.In addition, American patients are activists and expect their doctors to “do something” about their complaints.
People are also infatuated with technology, often believing that whatever is the newest must be the best. It is therefore often difficult and time consuming for physicians to convince patients that the best treatment for them may be to avoid tests, procedures, and medications and to instead rest and let some time pass. Furthermore, doctors may fear that if they do not act and something unexpected goes wrong, patients may sue.
After reading over some of the problems with care, I also read through some articles that spoke on the improvement of care. It made me think that american car makers, banks and manufactures of consumer electronics have all made emormous improvements in the quality of their products and services in the past ten to fifteen years, so does that mean we can expect the same evolution in health care? Personally I believe we hvae to over come certain obstacles that stand in the way.
Improving quality begins by defining excellent care for a condition or problem, a task that requires marshaling evidence from the research literature about the effectiveness of various treatments, adding expert judgment to the limited evidence base, and distilling this knowledge into clinical practice guidelines, detailed statements about what should and should not be done.20 Guidelines must be put to work to measure current practice. Then we must define shortfalls in quality, ascertain their causes, design and implement interventions and assess their impact, and sustain and enhance improvements.
Another obstacle is the difficulty of justifying the substantial expenditures the effort requires to chief financial officers as investments that are highly likely to produce financial returns. In short, the “business case” for quality improvement in health care is elusive. This predicament would be unfamiliar to those in business who have used a variety of techniques to improve quality and profitability at the same time. Most businesses have strong and consistent financial incentives to improve the quality of their products and services but
the same does not happen so uniformly in health care.
Another obstacle we face is a lack of demand for improvement. One might argue that even if broad-scale quality improvement cannot be supported by convincing return on investment calculations, it might be undertaken if consumers and their representatives were clamoring for it. Despite the volume of data documenting serious health care quality problems and the harm they do, providers experience little demand from consumers for substantial improvement in performance. Although consumers express concern about quality in general, the large majority rely on friends and family to recommend doctors and hospitals; they do not demand that providers produce evidence of better clinical quality or better health outcomes.
In conclusion, Some benefits fewer errors, improvements in the delivery of effective care, and reductions in unnecessary services are within the grasp of the comprehensive improvement effort we envision. Other benefits such as enhanced revenue, and increases in market share are not guaranteed. The time for consumer and providers need to step forward is now in order for changes to be made and obstacles to be knocked over.
1.www.abms.org/who_we_help/physicians/improving_quality.aspx
2.books.google.com › Medical › Administration
3.http://www.youtube.com/watch?v=nPdLqI_UPuI
Yes, technology does always seem to be the proposed answer. But the introduction of new technologies often change existing ways of doing things in significant ways. In my opion, we really need to "get our act together" before introducing new technologies intended to improve the quality of care. They are expensive "solutions." It is a gamble to go forward with a major new solution. I think my point is that there are "solutions" that do not involve new technologies that may be more prudent iniatives.
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