Quality is Not an Accident: The Planning for a Safe Journey Through the Healthcare System

Quality is Not an Accident: The Planning for a Safe Journey Through the Healthcare System

Vahé A. Kazandjian (ARALEZ Health LLC and Johns Hopkins Bloomberg School of Public Health, USA)
Copyright: © 2012 |Pages: 11
DOI: 10.4018/ijrqeh.2012040101


The communication between health care professionals and patients should go beyond the communication about the management of the disease – it should encompass educating patients about the knowledge available to treat the disease, the processes in place to enhance safe, effective and sustained performance. Accountability about the processes and outcomes of the care are expected to both demonstrate the social responsibilities of health care professionals and gauge the expectations of patients, families, and communities. The purpose of this article is to explore the determinants of what patients expect from healthcare and caring; how providers of care use available knowledge (or pseudo-knowledge) to apply their craft, and how information technologies assist in both the application of the available knowledge and the goodness of that application. Special focus is given to the role of physicians as educators rather than exclusively healers of disease and managers of patient complaints.
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A culture is perhaps most simply defined as the interaction of what people take for granted. Growing up in countries around the Mediterranean, I learned the importance of knowing what people took for granted. From “destiny will decide if you will have a child” to “big fish eat small fish”, culture was the environment within which we accepted, changed, or celebrated what we had. But the most important lesson I dearly cherish is the conscientious effort I make not to immediately challenge what is believed to be right or wrong, for that is what people take for granted.

This was (and remains) my guiding principle when, like many others, “accidentally” I became involved in the field of quality in heath care. Accidentally, because in 1982 I was a junior field epidemiologist in an Arab country in the Persian Gulf involved in helping the Ministry of Health build a national healthcare information infrastructure as well as construct primary care centers based on the “reservoir of need”, mainly involving maternal and child care. After establishing a baseline of need, the population distribution helped decide where to locate the centers. After a few months, we looked at utilization patterns in the centers. One center had a higher utilization rate than expected, and we decided to find out why. Since I spoke Arabic, I volunteered to interview patients and providers. When I entered the “Women and Children wing” of the center, I saw children running around and playing as if in a playground. Mothers, wearing the traditional Arabic dress, had most of their bodies covered, showing only their eyes, hands and feet. I approached one mother and asked what brought her to the health center. She told me she comes here every day, “mostly for a back pain”, and added that her 4 children always come with her. When I asked if her back pain was getting better, she said “may be, God willing it will be fine.” When I pushed more about the real reason for her visiting the center, she looked at me in surprise and said “but this is the only place in the desert that has cold water fountains and air conditioning!” I realized that we had built community centers not primary care clinics. And that was the “accident” which brought me to quality in health care.


This article touches on the topics of local expectations about quality, as influenced by the belief sets, i.e., what people take for granted. Within that context, I would like to discuss how education and communication about quality could be best structured and carried out. Finally, the role of information technologies as facilitators for such communication/education will be discussed.

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