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Health Care Analysis

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01.12.2007 | Original Article

Conceptualizing a Quality Plan for Healthcare

A Philosophical Reflection on the Relevance of the Health Profession to Society

verfasst von: S. Mehrdad Mohammadi, S. Farzad Mohammadi, Jerris R. Hedges

Erschienen in: Health Care Analysis | Ausgabe 4/2007

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Abstract

Today, health systems around the world are under pressure to create greater value for patients and society [81, p. 1, 119]; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating higher value in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts to healthcare in a conceptual format; we characterize the health system’s customers and outputs with their quality dimensions. The product of this effort is a blueprint for a customer-driven health system which identifies six types of customers, nine types of outputs and the associated operations. As a preliminary step, a new analysis and definition of health and disease is provided. Rethinking the structure of health system in this manner and the related conceptual model can guide medical research, health sciences education, and health services policy, and help the practitioner to integrate all modern trends in healthcare delivery.

For further study of evidence-based medicine (EBM) the reader may wish to review the following resources: (a) National Guidelines Clearinghouse available at: http://www.guideline.gov (b) Clinical Evidence, BMJ Publishing Group available at: http://www.clinicalevidence.org/ceweb/conditions/index.jsp (c) Evidence-based Practice, Agency for Healthcare Research and Quality available at: http://www.ahrq.gov/clinic/epcix.htm(d) National Library of Medicine’s Health Services/Technology Assessment Text (HSTAT), available at: http://gateway.nlm.nih.gov/gw/Cmd (e) Ovid, Evidence Based Medicine Reviews (EBMR). This combines four of the EBM resources: Cochrane Database of Systematic Reviews, The Database of Abstracts of Reviews of Effectiveness (DARE), ACP Journal Club—by the American College of Physicians, and Definitive Controlled Trials by the Cochrane Collaboration. Available at: http://www.ovid.com/site/catalog/DataBase/904.jsp (f) Comprehensive lists of EBM and clinical practice guidelines (CPGs) sites at: Netting the Evidence (available at: http://www.shef.ac.uk/scharr/ir/netting/http://www.shef.ac.uk/scharr/ir/netting/) and Lighter 2004, pp. 306–307 (see references).

The first three level 2 criteria shown above constitute an operationalization of health opportunity. It has to be emphasized that the lines marking the distinction between normal, compromised, and enhanced function are perceptual, i.e., based on an individual’s expectations, itself a function of his/her needs, experiences, and ideals. The lines generally are not determined by the medical profession’s standards of normality and pathology.

Here health system (or health profession) is not confined to the formal health system as defined by law or the entity organized as the health ministry; it includes relevant players in other sectors [e.g., authorities involved in environmental health, health education at schools etc. as well which would make up what is named as the virtual health system by WHO] [132, p. 132].

As said, we did not try to define the common medically related words of disease, sickness, illness, or health. We believe it is impossible to adequately define health/disease and that these concepts remain normative despite prior efforts to define them in an objective manner. There is no inherent external reality for disease. For example, a cancerous cell just expresses another kind of order which, incidentally, is not desired by us because it threatens our functions, well-being, and survival. Diseases have acted as proxies for description of conditions that have been undesirable and/or (somehow) controllable and/or unusual. Commonly we assign a disease etiology to a cause that is one of many contributing forces to a state, because it is one which we can more easily approach and possibly control. A collection of interacting biological, social, and ecological factors creates health; another overlapping, but differing collection creates ‘dis ease.’ Our health opportunity is to command these forces to our benefit, i.e., manipulate them so that we can live a longer, functionally more productive life.

An exception may exist where the individual if untreated or unrestrained/secluded may represent a danger to self or others. Examples include a patient with a highly infectious and often disabling disease (e.g., Ebola virus) who seeks to remain at large in the public or a patient with suicidal or homicidal ideation.

As mentioned, ‘normality’ (or ‘pathology’) is not of our concern in relation to a health opportunity (i.e., humanity’s current possibilities for action to improve function). In this sentence, we have used normal loosely and to make another point. This applies to other instances of such usages.

Value/purpose of functions lies in their potential for adaptation to/manipulation of the environment. This is their reason for being from an evolutionary perspective. This implies that the value of a function is relative. Comprehensive analysis of function and environment has been provided elsewhere [15, 77].

Under a topic known as quality costs in the quality management literature, it is argued that ‘quality is free,’ and it is poor quality that costs. Costs related to quality are categorized as: prevention cost, appraisal cost, and failure cost. These, in a classic industrial/manufacturing operation, are, e.g., costs of calibration, inspection, and rework respectively. It is then claimed and proved that the money spent in prevention (e.g., calibration) would translate into significant gain and saving at inspection and correction later. Moreover, this would bring about customer preference in the market which can result in even higher financial gain through better pricing or higher sales. This analysis, though, is not as straight-forward at the level of a healthcare organization; payments to the provider are not clearly related to the value/quality of the services offered. Sometimes there are perverse incentives (i.e., in effect rewarding poor quality), and the health market is not that competitive. Unneeded hospital stays may not necessarily be ‘punished’ for example. Yet it has to be emphasized that these analyses work at the broad national (whole system) level as discussed in the text.

It might be worth noting that despite the existence of high level of societal consensus over the desirability of outcomes (e.g., fewer medical errors, less unneeded referrals, fewer non-priority investments, etc.), establishing structural arrangements or nourishing societal norms that would reward and support behaviors and initiatives towards these outcomes remains a huge challenge.

For example, a person could elect to smoke in private despite the adverse health consequences, provided that a personal understanding of the health risks of smoking are known and that reasonable opportunities for smoking cessation exist. That being said, it would not be society’s (or the tobacco industry’s) responsibility to compensate the smoking customer for lost wages or an early death due to smoking related health problems. Similarly, the cost of smoking cessation programs and treatment for smoking-related illness would fall to the individual when limited resources do not permit societal subsidization of these services.

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Titel: Conceptualizing a Quality Plan for Healthcare
A Philosophical Reflection on the Relevance of the Health Profession to Society
verfasst von: S. Mehrdad Mohammadi
S. Farzad Mohammadi
Jerris R. Hedges
Publikationsdatum: 01.12.2007
Verlag: Springer US
Erschienen in: Health Care Analysis / Ausgabe 4/2007
Print ISSN: 1065-3058
Elektronische ISSN: 1573-3394
DOI: https://doi.org/10.1007/s10728-007-0071-7

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Conceptualizing a Quality Plan for Healthcare

A Philosophical Reflection on the Relevance of the Health Profession to Society

Abstract

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Abstract

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