Reaction to The Quality of Care: How Can It Be Assessed
Bill Castor
HPA 520, Section 1
Professor Meacham
September 13, 2006
Reaction to The Quality of Care: How Can It Be Assessed?
One of the newest trends in healthcare research is the study of the impact that the quality of care has on the measuring the effectiveness of our healthcare system. Attempting to study the impact of quality of care can be a difficult task to accomplish as many researchers are having trouble establishing the characteristics that would define the difference between a high quality of care and a poor quality of care. Dr. Avedis Donabedian attempts to accomplish this difficult task in his article The Quality of Care: How Can It Be Assessed? In his article, Dr. Donabedian defines several characteristics that can be used to help assess quality of care. These characteristics are: care by practitioners and other providers, amenities provided to the patient, care implemented by the patient, and care received by the community (Donabedian, 1997, p. 1743-1744).
During his discussion regarding the importance of medical care, Donabedian divides this characteristic into two important elements: technical performance and the interpersonal relationship (Donabedian, 1997, p. 1743). While technical performance was an element that was expected, I was very interested in learning more about the importance of the interpersonal relationship between the provider and the patient.
The Role of Communication
One of the main elements of the interpersonal relationship is the ability of the patient and provider to be able to communicate with each other. According to Donabedian (1997), “the patient communicates information necessary for arriving at a diagnosis, as well as the preferences necessary for selecting the most appropriate methods of care” (p. 1744). This process is extremely important in the ability to assess the effectiveness of the provider’s care because if communication is poor, the opportunity for misdiagnosis or improper treatment increases.
Importance of Communication from the Patient’s Point of View
A study performed by Carl Schneider helps to answer this question. According to his study, “When the question (What is good healthcare?) is posed specifically in terms of the patients' perception of their hospital experience, the emphasis shifts to issues of respect and communication” (Safavi, 2006, p. 216). Another study performed by J.D. Power and Associates found that “satisfaction with the hospital experience was driven (in order of importance) by dignity and respect, speed and efficiency, comfort, information and communication, and emotional support” (Safavi, 2006, p. 216). Lastly, a study performed by the Agency for Healthcare Research and Quality(AHRQ) and the Centers for Medicare and Medicaid Services (CMS) demonstrated that customers viewed the hospitals that had the best quality of care focused the best on several factors including: doctor communication skills and nursing and hospital staff communication skills (Safavi, 2006, p. 216). While all three of these studies emphasize the importance of communication, there are some other trends worth noting. The Agency for Healthcare Research and CMS study is interesting as it demonstrates that not only is patient to provider communication important, but also patient to nursing and hospital staff communication is important. In addition, the Schneider and JD Power and Associate studies show that there are other important areas of interpersonal relationships as well such as dignity and respect and emotional support.
Importance of Communication From the Provider’s Point of View
As you can see in the previous studies, the role of communication is becoming more important in being able to provide quality care to patients. The provider community is starting to respond to these demands. One example of this reaction comes from additional training courses that medical schools require of their students. In order to complete these courses, students must take an exam that “gauges what multiple-choice questions cannot: a student's ability to communicate with patients, gather information, conduct physical exams and diagnose illness” (Ackerman, Sept. 27, 2004 p.1). What is the benefit of these exams? According to an interview with Dr. Peter Scoles, senior vice president for assessment programs at the National Board of Medical Examiners, “a large body of literature has found poor communication and lax general clinical skills are related to a higher incidence of malpractice suits, lower treatment compliance by patients and decreased patient satisfaction” (Ackerman, Sept. 27, 2004, p.1) By requiring that all medical students take these exams, hopefully future generations of doctors will be able to improve their communication skills and lead to an overall better quality of patient care.
Other Aspects of the Interpersonal Relationship
As mentioned previously, there are other important aspects of the interpersonal relationship such as dignity, respect and emotional support. Donabedian adds several more aspects such as privacy, confidentiality, informed choice, concern, honesty, and tact (1997, p. 1744). One aspect not discussed specifically in his article but I feel is implied is another important aspect of the interpersonal relationship, trust. Trust is very important in order to have a strong doctor/patient relationship. If the patient does not trust that the doctor will keep information confidential, they may keep important medical information from the doctor. As a result, a doctor could misdiagnose a patient’s condition. In addition, if the patient does not trust the provider, they may ignore medical directions given by the doctor. According to a study performed by David Thom and colleagues, “62 percent of patients in the highest quartile of trust reported that they always took prescribed medication and followed their doctor's recommendation, compared with just 14 percent of patients in the lowest trust quartile” (Thom, Hall, Pawlson, 2004, p. 126). As you can see from this study, trust is very large determinant as to whether a patient will follow a doctor’s instruction.
Another implication of trust is whether a patient decides to keep the same doctor (Thom, Hall, Pawlson, 2004, p. 126). Thom and colleagues study showed that “that after six months, only 3 percent of patients in the highest trust quartile had left their physician, compared with 24 percent of patients in the lowest quartile” (Thom, Hall, Pawlson, 2004, p. 126). As you can see, if a provider fails to gain the trust of the patient, not only could it have a negative effect on the health of the patient (i.e. ignoring doctor’s instructions), but also could financially have an effect on providers (i.e. losing patient’s business).
Conclusions
As the studies mentioned previously show, the ability of the provider to be able to facilitate an effective interpersonal relationship with their patients is crucial in improving the care that providers supply to their patients. As a result, if providers can focus on improving their interpersonal skills, we may be able to see an increase in the quality of care in this country.
References
Ackerman, Todd (2004,September27). Assessing Bedside Manner / New test has med students playing doctor / Expense, travel draw complaints of medical groups:[3 STAR Edition].Houston Chronicle,p.1. Retrieved, from National Newspapers (27)database. (Document ID:700524401).
Donabedian, Avedis (1988, September 23/30). The Quality of Care: How Can It Be Assessed? Journal of the American Medical Association, 260(12), p. 1743-1744.
Safavi, Kaveh (2006). Patient-Centered Pay for Performance: Are We Missing the Target?Journal of Healthcare Management,51(4),215-218. Retrieved, from ABI/INFORM Globaldatabase. (Document ID:1092901941).
Thom, David H,Hall Mark A,Pawlson L Gregory.(2004). Measuring Patients' Trust In Physicians When Assessing Quality Of Care.Health Affairs,23(4),124-132. Retrieved, from ABI/INFORM Globaldatabase. (Document ID:661524801).