What I learnt this week: Quality is not one box to tick #WILTW

This is the 57th #WILTW

I showed the following video at our Paediatric Emergency Department Senior Team meeting this week (you may need to watch directly on youtube as embedding has been disabled: link)

I was talking on the theme of quality as I’m developing a research programme to look at Quality Indicators in Children’s Emergency Care. The video is clearly of comedic, rather than clinical value, but like many health-care parodies there is always that nugget of truth which makes you feel uncomfortable. There are many ways of describing quality (a short presentation I use is here) but an often cited approach is that used by the United States Institute of Medicine: Safe, Effective, Person Centered, Timely, Effecient and Equitable care. A spin on this approach by the US institute for Healthcare improvement is:

Quality Matrix

I think most people would agree with the general domains. What is challenging is the interpretation of the some of the specifics. Kate Granger kicked off her Hello my name is tour in Leicester this week. While some may argue an introduction isn’t a sign of quality (it’s a fundamental part of basic communication!) it is a vital process. Or is it?

I was made aware this week of a situation where a health care professional hadn’t introduced themsleves clearly. However this wasn’t noticed by the patient but by their friend who happened to be a health care professional themselves. In the midst of a busy healthcare environment what was perceived to have been the biggest arbiter of quality was a definition of the problem and its solution. How often does a failed #hellomynameis get overlooked because the patient is concerned about a different aspect of care? The variation in perception of quality may explain why it is possible for a department at exactly the same time to receive both a compliment and a complaint about the care provided.

The challenge is which aspects of quality to look at? It is currently not possible, or desirable, to look at everything simultaneously. For example is the Friends & Family test alone an adequate measure of patient experience? What is for sure is that a suite of measures is needed; acknowledging quality is not a thing but a culture. Quality should never be one box to tick.

What have you learnt this week? #WILTW

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