What I learnt this week: Is quality defined by a standard of care you didn’t expect to receive? #WILTW

This is the 86th #WILTW

I delivered a workshop on Quality Improvement this week for our regional trainee leadership development programme. The background and links to it can be found here.

I start the session by exploring the participant’s experiences of good and bad care in the NHS. There is a sad recurring theme. A splattering of good experiences and a forest of hands for the bad. Minimal examples of poor clinical decision making or technical problems but lots of stories of long waits without explanation, having to push, push, push to find out answers and depressing tales of nonchalant and dismissive staff.  My observation is there has been little change over the two years I have been doing this.

We then move on to a definition of quality. I deliberately bias the group by discussing experiences first as I think this is an important reflection. We have a group discussion about what the group have suggested and then go on to review the Institute of Medicine’s Six Domains and the institute for Healthcare Improvement’s version of it:

Quality Matrix
From Institute for Healthcare Improvement: Closing the Quality Gap http://www.ihi.org/about/Documents/IntroductiontoIHIBrochureDec10.pdf

One suggestion for a definition of quality was presented which I hadn’t had before:

Quality is when something occurs that is better than you expected to happen

There are many holes you can pick in this statement if you wish. But what I like about it is it explains those times when a family seem unduly grateful for the care you given them. It can be something very minor like checking on a patient you have admitted the day before, taking that extra 20-30s to comment on a game a child is playing with or providing a shoulder to cry on for the distressed parent. These are things that are normal ‘clinical’ tasks but may be perceived as being an unexpected addition to care by some.

When was the last time you felt you have experienced a quality service? Not necessarily in a healthcare setting, maybe a hotel visit or buying a car. What it really something that was above and beyond what should have happened? Or just that you didn’t expect that it to  happen in that environment…

Ultimately it poses a deeper challenge of if you have to think about delivering quality care, you are probably not delivering it. The best care is probably truly unconsciousness in you.

What have you learnt this week? #WILTW

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