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A Peek Inside Quality of Care

Posted Aug 23 2008 10:37pm
The last time I needed general anesthesia, I was five years old. The last time I needed an IV was thirty one years ago! Knock on wood, for real!

I'll keep the juicy details to myself, but the procedure I underwent today was interesting to say the least. I suppose every interaction with the health care system, upon which I pontificate with such earnestness, becomes an opportunity for reflection.

I was at an out-patient surgi-center accredited by The Accreditation Association for Ambulatory Care , not the Joint Commission . Yet another reminder that there are alternatives to the current accreditation structure enshrined in Congress' instruction to CMS. The principles of patient safety are straightforward and best practices are not intended to be expensive secrets.

The first thing I noticed was the regularity of all the questions required to assure safe surgery; name, DOB, surgeon and procedure were verified ad nauseum . Well, three times to be exact. It was busy and you could tell. The nurse that called me in from the waiting room butchered my name while carrying on a conversation with someone down the hall on the way to my changing room. She was one of those old-school nurses who has the answers for anyone on the floor who needs a hand. I trained with nurses like that and they're great. They are all business and have little time for molly-coddling. Everyone else acted with requisite sensitivity and professionalism, but you couldn't help but notice the fact that they were hurried.

The surgeon came highly recommended. He was one of the first in the valley and is known as a consummate, fast, precise proceduralist. Again, he is a no crap kind of guy; my wife's response was "No bedside matter. None. Whatsoever." It made me think of the Joint Commission again and their "bad boy" witch-hunt . Just to be clear, my surgeon is not the type to throw temper tantrums and such behavior is not acceptable under any circumstances, but there are better responses than a bureacratic regulation by an accreditation agency. As an aside; there's no crying in baseball and no whining in medicine!

Across the street is a Planetree affiliate hospital where my wife had her surgery a couple of months ago. They were every bit as professional as the surgery center , but the level of hand-holding compassion, empathy and care was just what my wife needed. This "patient-centered" approach is what gets you designated a Planetree hospital and I appreciated it more that I can ever articulate. This is the quality that most consumers see and what they frequently understand as quality of care.

I was more concerned with the manual skill and judgment of my surgeon and even that is purely subjective information gleaned by word of mouth. I was looking for qualitative information which cannot be expressed in numbers or percentages. Either way, I have regualry been impressed by the level of skill and compassion to be found in this little Western desert town. It's a darn sight better than anything we had in Maryland. And Atlanta... puh-lease!

I think the wave of consumerism overtaking health care is a good thing; after all we are all in it for the patients. But we would all be well-served to remember that quality has many nuances. Patient satisfaction is determined by "soft" features of health care delivery; things like compassion, caring and cleanliness. They offer dignity, more than anything else. Important as dignity is and as much as I appreciated the Planetree experience, it is not "right patient, right intervention, right time" which is all we know how to measure accurately.

Given my interest in quality of care, the uninsured and the public health impact of health care, it raises some other interesting questions. I believe that everyone is entitled to basic quality health care, but quality costs money. Oak-panelled walls and Louis XV chairs in wating room with a library of 19th century first editions make me happy, but if we define quality in terms of hotel services, speed of service and Planetree-style amenities, we may not be able to afford Healthcare for All. There is a fundamental conflict between two currents which I see as part of the same consumer-based movement.

Quality costs money and at the end of the day, we have to decide how much of it we can pay for and perhaps try to define what aspects.
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