There are many articles written and blogs posted that try to define the term 'quality healthcare.' One camp believes that the average person (patient) is totally unqualified to render an opinion as to the quality level of healthcare that they received. Since patients do not possess knowledge about disease processes and the appropriate treatment of said disease, they should accept the fact that their continued existence is sufficient evidence that they received quality care. In other words, a patient wouldn't know good healthcare if he tripped over it.
The other side of this argument is that good healthcare is composed of several components. Good medicine is important but so is the patient's perception of the care they received. In other words, we need to provide medical care in a manner that is pleasing to the patient. This is not an implausible argument as I will illustrate next.
Many people have experience as consumers in the food service industry. We all have our favorite eateries and restaurants, our preferred foods and drinks. I know some people who make detailed plans to partake of the culinary delights that a new restaurant opening promises. Often, these eateries promote their showcase meals with a great deal of fanfare. Many restaurants highlight the presence of an esteemed chef on their premises.
What if you went to a great restaurant with the expectation of a great meal? When you arrive 5 minutes before your reservation, you are given a pager and told that things are running behind - you will be notified when they have an opening for your party. Thirty minutes later your pager goes off and you are shown to a table next to the kitchen entrance. You review the menu one more time (you just had thirty minutes to review in detail) and wait for someone from the wait staff to visit your table. Eventually, someone does arrive to take your drink order. Ten minutes later, your drinks arrive and you are asked if you have decided on your food selection. After placing your order you sit in anticipation of a scrumptious meal. Soon, your food arrives. However, you asked for asparagus, not the green beans that currently grace your plate. A promise of asparagus is given to you and your glass of iced tea is refilled. Unfortunately, you originally ordered unsweetened tea and the refill was with sweet tea. After finishing your meal (the asparagus never arrived), you have to flag down someone to request your bill.
So, how was your meal? If you ask the chef, he will tell you that he prepared a meal that was technically correct, artfully crafted and plated with a great deal of thought towards the perfect presentation. After the long wait, poor service and indifferent attitude of the wait staff, most people will not return in the foreseeable future and will probably tell their friends (in person and via multiple electronic formats) to avoid this restaurant at all cost.
Some people see medicine as the chef saw his food; five star quality. Yes, the food was very good but how that food was served totally eclipsed the quality of that food. And so it is with the patient experience. We can render five star medical care but if that care is served with an attitude of take it or leave it, we will suffer the consequences.
The advent of value based purchasing (VBP) has added a new dimension to how the patient perceives the care that they receive. Prior to this program, a poor patient experience might have resulted in negative comments or a complaint being registered with the medical facility. There was no measureable effect associated with rendering poor quality care or great quality care. VBP has changed this. Now we will be able to measure, in reimbursement dollars, the positive and negative effect of the patient experience. No longer will the marketing departments in healthcare be the sole group concerned with providing a positive patient experience. Now, the accounting department and the inhabitants of the C-suite will be able to see a measureable difference in the quality of care provided and how that care was perceived by the patient. We will finally be able to see the return on investment of a few kind words, a caring attitude and a smile.
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