Our definitions of quality

What is your preferred quality domain, all things being equal?

Answer
Votes
Percent




Effectiveness
8
47%


Patient-centeredness
4
24%


Equity
2
12%


Safety
1
6%


Timeliness
1
6%


Efficiency
1
6%

It wasn’t a big poll, but I find the answers interesting. I asked you what the most important quality domain was. There’s nothing statistically significant here, because only 17 of you responded. (If this was just 1 person responding 17 times, let me warn you that the punishment for screwing around is severe and swift. This is a serious blog.)

What catches my eye are the several choices that lost out and ended up at the bottom: safety, timeliness, and efficiency. It could be that people didn’t really understand what these meant. (Timeliness – that medical care be delivered at the right time, i.e. neither too early nor too late; efficiency – that resources not be wasted, or underutilized, in delivering the care.) 

Safety, though, is surely something that everyone understands. Why didn’t it get more votes? There’s no clear answer from this unscientific effort, but here are some speculative possibilities:

It’s something everyone assumes already exists, until they are themselves affected by subpar safety. Who judges an airline or a car by its safety record? Maybe we don’t talk about those things because we assumed that someone, somewhere, is ensuring the safety of our airline travel or automobile  manufacture. Certain people, by pointing out governmental and private negligence, have forced us to pay attention to things we might not want to notice. The same is true of healthcare, but maybe that just hasn’t registered yet.

Or perhaps, subconsciously at least, the category “effectiveness” already folds in safety. If we are delivered quality care, we already assume that it will be done without errors – certainly without serious error. If our gall bladder were removed without a trace but then we got a blood clot in our leg, we might not consider that an effective cholecystectomy!

However, apart from our individual preferences, the real reason I put up this poll was to illuminate a larger problem. There is precious little research on what patients think is meant by high-quality healthcare. If we make use of new public reporting mechanisms (or reporting done by private concerns, like Consumer Reports) to tell us which doctors or hospitals are better, we should make sure that we understand and agree with the criteria.