Defining Quality

One of the ongoing discussions in the health care industry is how do we define quality?

In acute care hospitals, the government has established report cards and uses those as a measure of quality. Most consumers/patients do not read these report cards before they go for services. They simply ask someone who they liked and whether they were "good" or not.

This is a sticking point between my parents and I. We continuously battle about which is the “right way” to choose a care provider. My father defines quality by whether or not he likes the doctor - meaning is he/she personable. My mother makes her decision based on whether or not the person will tolerate her eight million questions, give her all of the tests and prescriptions she wants and whether or not her office bills correctly so she doesn't have to fight with her insurance company.

We know that one of the ways people judge quality is based on our Press, Ganey surveys. How does the parent feel about the care we gave? Some would argue that like my Dad, the doctor may be really nice but is that really the way to judge the care given?

Our parents rely on Children's Specialized Hospital to do the screening for them. To find the highest qualified staff who will provide the best quality of care. We wouldn't hire people that weren't high quality and therefore that is something they don't worry about.

The question of how we define quality is often subjective. We observe practice patterns. We rely on supervisors to model and mentor and yes, we use Press, Ganey surveys to give us an indication if something is not going well.

The federal government has told us that they are going to pay hospitals more if they have good quality. Since we don't have a federally accepted report card, many of you are working on "proving" that our care is high quality. This is going to require us to delve more into research and partner with others in order to validate what we do. I know we can do it!

Another pressure we are facing is that quality is now tied to price. Can your hospital operate with what you are reimbursed? If you can't, there is an assumption that your hospital is not efficient and that signifies a problem. We can argue that as a pediatric rehabilitation provider there are a lot of nuances and differences for the cost issue. The State of New Jersey is looking at a $10 billion budget deficit, they aren't going to care about our differences. They are telling us the money has run out and we are going to have to do with less, unless we prove our worth and our outstanding of quality care.

So, we are looking at all of these aspects of quality. Looking at identifying things we can do differently, smarter, with more efficiency and to get better outcomes for our children and our employees.

The major reason we moved to an electronic medical record was to improve the quality of the care we delivered and to hopefully make all of our lives easier in using one system. We know in December that we had NO missed doses or medical errors with pharmacy. Some would contend that our new bar coding system is working. Outpatient therapists are telling me that there are definite improvements in being able to do evaluations and get their billing done.

So let me ask you - are there things that we can do to improve quality? Are there things we can do today to improve our efficiency?

These are conversations your directors are going to have with you over the coming weeks. They will look to you to give them great ideas and guidance so we can continue our move to excellence.