Tag Archives: Healthcare Quality Measures

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How Does Customer Care Fit in Health Care Quality?

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In my previous post I cited an example from real life how a hospital experience with a good clinical outcome was negatively affected by poor customer service.

Customer Care has taken on an even greater role in our society thanks to the internet and social media.  Bad customer experiences get spread quickly, often with significant negative results to the individual or organization providing the service.  More of us check out Customer Reviews of services and products before we make our purchases.  It is only natural that this means of evaluation is being applied to the delivery of health care.

Many patients take technical quality for granted.  For example, they assume that all Board Certified interventional cardiologists perform cardiac catheterizations equally well, just like all auto mechanics perform oil changes equally well.  For the diagnosis and treatment of the non-complicated cases, that assumption is pretty much correct.  It is with the more unusual or complicated cases that the level of competence plays a role in outcomes.

Since most patients can’t judge the clinical quality of most aspects of medical care, they often look to the quality of customer service to judge the quality of their care.  In addition, patients these days expect both technical and customer service excellence.  Gone are the days when the doctor is placed on a pedestal, where he can do no wrong and his advice must be followed without question.  This change in perspective underscores the importance of good physician-patient communication.  Ideally, the experienced physician should anticipate the questions and concerns of his patients and address them proactively.  He must take a personal approach with every patient.  My friend’s experience with the physician who saved her life but didn’t communicate with her left a lot to be desired in this dimension of her care experience.

The personalized approach also applies to the other staff who interact with patients, from the medical office receptionist to the nurse in the office or hospital.  In my friend’s case, the Nursing Assistant could have looked beyond the task she had to do and realize that she should have made adjustments in when and how she measured my friend’s temperature.  Likewise, the nurse who noted that my friend did not have a fever, but claimed that she was powerless to stop the unnecessary tests, should have used her common sense and contacted her supervisor to prevent the waste of resources and inconvenience to my friend.  Had they put themselves in my friend’s place, I think they would have found a way.

I don’t think we have to compromise on the extent of the quality of care that is delivered.  We shouldn’t have to settle and compromise because the technical procedure was a success.  We should have quality in all aspects of patient care, and, as the episode with the fictitious fever in my previous post demonstrates, save money in the process.

The question remains, what can the average patient do to get optimal care from both the technical and customer service perspectives?  I’ll offer some suggestions in my next post.

For Your Health – Dr. Bob

More On Healthcare Quality

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In my last post about using the healthcare system, I talked about patient satisfaction surveys as a way to measure its quality.  But measuring satisfaction is only part of health care quality.  You may be satisfied with the care your physician provides, but is it medically appropriate and up-to-date?

Another kind of measure looks at how well all the doctor’s patients with certain common characteristics stack up against some specialty recommendations.  This approach works well for preventive measures for patients of a certain gender and age, such as, immunizations for children or mammography rates for women.  It’s also used to measure care delivered to patients with certain chronic conditions, such as diabetes or heart failure.  These measures cover whether certain tests have been performed on a regular basis and whether certain medications proven to be effective in managing the condition are being taken by the patient.  They also may include what percentage of the patients with the condition are under control by attaining certain standards, such as blood pressure or the A1C level for the diabetic.

There are certain problems with these measures.  First, sometimes more than one medical organization releases conflicting recommendations for the same test or procedure.  For example, the United States Preventive Services Task Force (USPSTF) recommends screening mammograms for women every other year after the age of 50, whereas the American Cancer Society (ACS)  recommends that it be done every year after the age of 40.  Which should be used?  Another problem with some of these measures is that they don’t always accurately reflect the physician’s practice.  With most of them, the physician may order a test or a medication, but the patient must follow through and have the test done or fill the prescription and take the medication.  Another weakness of these measures is that while they can work for primary care and some specialties, they can’t be applied to all specialists.  With time more specialty-specific measures may be developed.  Finally, gathering the data to do the calculations can be a problem, though as more and more practices adopt an electronic medical record, that problem may be reduced.  More about that in the next post, when I discuss clinical pathways.

Some health plans publish some of these kinds of measures for their physician network.  Have you ever seen them or used them?  Please share your experiences with healthcare quality by leaving a comment.

For Your Health – Dr. Bob