This quote from a book I’m reading (and shall review in a later post) got me going:
“Although price in healthcare is also important, when people are looking for healthcare services, quality services will almost always outweigh price“.
The book then goes on to emphasize that, with the changing marketplace of consumer-driven healthcare, it’s important to be able to demonstrate quality in order to entice patients to join or stick with your practice!
What then is Quality?
The Institute of Medicine, in its Crossing the Chasm Initiative says this:
“Quality in healthcare is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
From a practical standpoint, quality is going to be best demonstrated by (with some examples in parentheses):
- Recognizing who’s at risk for what diseases: regular age-appropriate screening, gene testing for chronic disease?
- Providing convenient and timely access to the necessary medical services: convenient scheduling for affordable visits
- Providing an appropriate assessment and evaluation: a thorough H and P, coupled with excellent listening skills and your finely honed intuition
- Making the most correct diagnosis or diagnoses: evidence-based medicine, using a clinical decision-support tool?
- Starting the right treatment at the right time, while also considering the patient’s preferences and circumstances: informed consent, including the family in decision-making where appropriate, specialty consultation where necessary
- Ensuring the appropriate follow-up: electronic or manual tickler systems, timely follow-up intervals, reminder emails or phone calls
- Motivating the patient to stick to their treatment regimens: providing health coaching to follow up, using motivational interviewing
Patients typically lack the sophistication to be able to truly evaluate many of these “quality actions or behaviors”. Heck, when I sent a patient to a surgeon for an evaluation and likely operation, I couldn’t be certain which the best surgeons really were. My referrals were based on educated guesses, physician community reputations and happy patients reporting back to me.
Instead, patients will judge you and your practice’s quality based on how helpful your receptionist was on the phone, how quickly they could get in to see you, how long they had to flip through out-dated magazines while waiting for their appointment, the warmth of your tone and your receptiveness to their questions and whether they could make head or tail of your bill!
And yet, in many of the managed care and pay-for-performance environments, you’ll be judged on very different criteria.
As a physician hell-bent on thriving in a competitive marketplace, which parts of your practice must you systematically tackle in order to demonstrate the best quality?