Quality and Efficiency
Let's define quality here as conformance to standards of care AND satisfaction of customer needs. I say "and" to include both technical and service aspects of healthcare. Quality initiatives have been criticized because they neglect cost. For example, the NQF has been developing standards for care of specific conditions and settings without regard for the cost of these changes or assessment of the value to the patient. If there is any improvement in efficiency, it is an accident. In fairness, these standards should create better results for the patient and this should reduce costs to the system. However, cost considerations are not part of the standards and thus many of these may have a negative effect on efficiency. It is possible to increase the quality of care while decreasing cost, but that won't happen by accident. Plan for success! For example, it is possible to reduce or eliminate nausea and vomiting after anesthesia by judicious choice of anesthetic drugs and techniques. The result is a shorter stay in recovery room (decreased cost) and a happier patient (improved quality). Accessible scheduling can even out patient flow in urgent care centers. Reduced waiting time pleases patients, and improved provider productivity reduces cost. The combination in either case means improved efficiency and improved quality. Sometimes, you need to start with a clean slate to plan a new patient care process with due consideration to both cost and quality. QFD anyone?
Comments
When Dr. Deming was around, he did not focus as much on cost as he did on the processes and quality of the outcomes. His approach was if you eliminated waste in your processes and met the customer requirements, the finances would work out. That is an oversimplification because he did want you to have all processes (including accounting) operating efficiently.
Mickey
Posted by: Mickey | November 18, 2005 11:55 AM
Yes, In fact Dr. Deming touted a Chain Reaction, where folks that improved the process, saved the 4 types of costs (mostly reducing internal and external failures), and improved the products and services to customers, ultimately brought in more customers and provided more jobs.
Posted by: Mattie Groves | December 2, 2005 07:43 AM
Statements like: Quality initiatives have been criticized because they neglect cost, are a problem with our healthcare leaders who don't implement real quality initiatives, but rather drive their own personal agendas "in the name of quality." Even improving efficiency (if that's all you do) is a miscarriage of a quality initiative. Quality is definitely customer satisfaction, but it's also reducing cost, and improving productivity. A 3-legged stool has long been an analogy folks use. But no one should say: "it's satisfying 100% of the patients, with minutes, and at zero costs." The aim should be on improving the processes and innovating the methods and deliverables so that the maximum amount of patients have a very positive healthcare experience in a timely manner and at a reasonable cost.
Efficiency doesn't come from Nurse vs. patient statistics. You have to capture the root causes of why a process is inefficient. Then work to improve or reengineer the process, or reinvent the deliverable. It doesn't happen overnight, and it doesn't happen by whipping the healthcare employee to work harder in archaic healthcare systems that don't serve the patient. Too often I've heard of cattle-car rules that move the patients through at extreme speed (e.g. birth mothers out-the-door in 24 hours). What's the cost of a mother bleeding to death at home, or a baby starving to death because of inadequate nursing instructions or an insufficient milk supply. These problems increased due to effort to "move them through the system" and not accepting the fact that not all patients are the same. Also cost-cutting measures that eliminate experienced nurses for a lower cost "just out of college nurse" is putting patients at risk. We need to continue our mentoring programs, and differentiate ourselves from the cattle-car health providers.
Posted by: Mattie Groves | December 2, 2005 10:28 PM