The measurement and evaluation of healthcare services’ quality is faced with the challenge of describing its appropriateness. Is the right service rendered for the specific disease? Or do our measures quantify the efficiency of producing these services without first assessing if they were needed? Eventually, it is a question of accountability about the processes and outcomes of the care, which 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 chapter is to explore the determinants of what and why patients expect from healthcare and caring. Within the concept of accountability, the role of physicians as educators rather than exclusively healers of disease is explored.
TopIntroduction
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, even if à priori I may not always know the intrinsic rationale for their belief system
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 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. .
Purpose
This article touches on the topics of local expectations about quality, as influenced by the belief sets, i.e., what people (patients and providers) 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.