An in-depth look into the Definition of Quality of Medical Care and current Misconceptions around its True Essence

Quality is relative, as every person has its perception of a better service or a good. Even the same person may or may not characterize the quality as being perfect objectively for somebody else, while at the same instant, he or she may see it as not so good subjectively. The concept of quality becomes even more intricate when applying it in the healthcare domain and medical practice. For that reason, we open the door to so many questions once we start bundling the quality and value of a medical service based on the set factors or criteria, such as country X has better healthcare than country Y, or doing A entails better care for everyone.

Today we are on the fast track towards a value-based healthcare delivery model, so the answer to the questions like “Which country has the best healthcare system in the world?”- has no more weight, as it had when it was a fee-for-service; unless we all, as patients and physicians, agree on some predetermined standards. But, is it really what medical care is all about?! Or is it about keeping a patient healthy and happy? — not just physically and mentally but also socioeconomically.

To answer the question of- “Who gets the best Medical Care and where; it requires Defining Healthcare

The measure of quality in healthcare is a delicate one, particularly in today’s ever bureaucratized care system. The more we embrace corporate style medical care, the further we move away from the personal vision of quality and rely solely on the collective determinants of a good deliverable. There are many social determinants of quality of care and health within the 21st-century population health model defined as the optimal care, such as maintaining blood pressure or blood glucose below a certain level, even though such numbers are simply the product of observations by a group of people. As accurate as they may seem, nevertheless are not perfect; “Human health is not absolute, neither medicine is a perfect science.” In general, however, healthcare is the logistics that can be offered at a particular place and era into one specific person in line with the objective determination of the patient’s treating doctor and subjective expectation.

Complexity is the Inherent Human Nature (medium.com)

Quality and its Determinants

Quality is an attribute or characteristic of a tangible object or service that sets it apart from its kind. However, defining what entails the highest quality is not as straightforward, especially if we exclude the users or persons directly involved concerning that particular service or the product. Common sense plays a decisive role in the definition of quality and tends to see quality related to subjective feelings or objective evidence. The rate can also apply to something that depends on the standards being implemented and, from a neutral point of view, does not determine its value. Someone may perceive something to be good merely because it is useful. After all, it is attractive, or simply because it is there. Then again, identifying quality requires distinguishing what is useful, substantially engaging, and what exists. Commonly, quality can mean a measure of excellence, as in “a quality product” or “work of average quality,” but again, who determines the standard of excellence?

The last question’s answer may be more straightforward once we apply it to a fundamental science such as engineering. For example, a better home may be earthquake resistant, warm, and in a safe neighborhood, even though it is still not perfect. But the aggressive medical treatment of a dying patient may entail more suffering and pain, hence the low quality. In contrast, the same treatment may seem ideal for a young, otherwise healthy person in a deprived neighborhood.

Relativity of quality and value is factual, more so concerning medical science. But- we seem to be moving away from that notion. We instead are embracing a vision of quality from an economic perspective rather than the real personal variance.

Subjective and Objective Expectation and Measure of the Country’s Healthcare Quality

Although medical care quality is personal, it is often applied collectively to community standards and even countrywide. Naturally, if the particular community is culturally homogeneous, one should expect a lesser discrepancy in objective and subjective expectations on the quality. However, once the same community starts to diversify culturally, and public expectations flinch to rise, such standards begin to crumble into fictitious determinants. Then the ultimate bureaucratic solution shall simply rely on economic criteria, rather than personal evaluations.

Once we start generalizing healthcare quality on a country basis and comparing them to each other, we are merely hoping that everyone or the majority will be happy with their medical care. The latter is hardly the case in today’s highly expectant societies. One country may see another as the best- simply because they don’t have what patients in other countries cherish, and vice versa. Let’s say- it seems the grass is greener on the other side! Or furthermore, there is a discrepancy between objective and subjective perception within those societies or in a person’s mind. For instance, someone residing in the country without the 3rd party payer system may see national healthcare coverage as the measure of high quality. Still, the latter patient may feel national healthcare is failing him simply because he has to be on a long waiting list to get elective surgery.

Objective and Subjective Quality

Objective quality is the kind in which a person sees the best fit for another person. This type of quality typically pertains to professional interactions, such as physician treating a patient. Objective eminence is at least partially based on the target person (e.g., patient) as well, but it ultimately rests in the evaluator’s hands. A physician’s contribution to patient care is vital for the quality of the service he renders but must also be in concordance with patients’ subjective perception.

Spiral Project Management Methodology in Healthcare (medium.com)

Subjective quality is patient dependent and factors in the person’s understanding of the care, expectation, and needs. In addition to entertaining patients’ desired outcomes, it also ensures their engagement and compliance towards even better care and healthier life in the future. We also need to keep in mind that subjective quality without objectivity of the treating doctor can be counterproductive as it potentially disregards the professional component of such quality. Therefore, the Balance of objective and subjective quality is essential in everything, more so in healthcare. But then again, that must be solely applied to individual scenarios such as personal doctor-patient interaction.

Recently we can’t avoid hearing about quality care and value-based medical service. Not because; what makes the latter different is its economic origin and corporate mission as a quality measure server. Although some evidence may back that, nonetheless, such evidence is Executive-driven quality standards, which not only are fictitious, but most of all are the biggest disruptors of the objective and subjective quality balance.

Profit-Driven Quality is not the same as Real Quality

The new value-based reimbursement is economic quality, and any state’s economy, if not all today, is very much influenced by corporations and corporatism. For instance, today’s health insurance industry (along with pharmaceuticals) is the Sole price setter of the entire healthcare reimbursement and a significant player in setting quality medical care standards. And since the third-party payers (insurance industry) are generally for-profit, it utters them within a considerable interest conflict. Then one should wonder what kind of quality would be if corporations authorize the quality of care. Imagine how much profit an insurance industry can make by merely manipulating physicians’ clinical judgment. Yes- that is what is precisely happening today. Then how can we decide which country has the number one healthcare?

Because Medicine is the Science of Relativity but does everyone see the Same Way?

According to economists, healthcare quality is about the issues relevant to efficiency, effectiveness, value, and behavior in the production and consumption of healthcare resources. However, it is crucial to determine how to improve health outcomes and lifestyle patterns through interactions between individuals, healthcare providers, and clinical settings. Economist vision of quality healthcare is around healthcare systems operations and general behaviors such as smoking, diabetes, and obesity. In reality, it places more emphasis on government intervention, intractable unpredictability, asymmetric information, blocks to admission, externality, and the occurrence of a third-party agent. Health economists, thus, is merely about evaluating costs, charges, and expenditures. What is Uncertain for the economist is intrinsic to health itself, the kind of knowledge gap that is present between a physician and a patient, also called asymmetric information.

From a Politician perspective, healthcare is another mindset where the whole objective is to gain the populace’s votes, where such gain is not necessarily tactic oriented. Instead, as we often see, healthcare is one of the topics that serve the politicians’ interest more than economists or medical professionals. Politicians use the buzzwords around the healthcare domain to gain their constituents’ support, with or without real quality concern.

Personalized Healthcare – the True Definition (medium.com)

Political debates are loaded with utter rhetoric aimed to stimulate their political base, and, as such, are often not taken seriously. But piercing through the rhetoric, there are often concepts of substance, good or bad. But none is based on real quality measures, be it objective, subjective, economic, or philosophical.

A businessperson sees better quality healthcare delivered to patients in conjunction with the negative cost-revenue; trustworthiness is an excellent motivator amongst healthcare professionals. Because such quality is an equivalently powerful business strategy, with a real influence on the overall wellness of an organization and its financial performance. For a businessman, healthcare delivery waste translates into higher costs and worsening upshots for patients. From the business point of view, establishments can diminish waste, and enhance the bottom line, with clinical quality strategies. This may still, but at times, just like an economist’s vision, may overlook the patient’s and physicians’ subjective and objective personal factors.

Businesses commonly utilize lean project management methodologies to address waste reduction. Scholars such as William Edwards Deming taught that by adopting the appropriate management principles, organizations could increase quality and simultaneously reduce costs. The key to Deming’s strategy is to practice perpetual improvement and think of the business process as a holistic system, not as separate departments. Such a holistic healthcare system is known as team-based care, a collaborative, goal-oriented approach to patient-centered care that directly impacts a health system’s bottom line. I concede with the goal-oriented approach concept as long as the quality measures also incorporate individual circumstances in every patient care. It should include the physical outcome of the product or service, results of the interaction between the service and its consumer in the care delivery experience, patient satisfaction, and cost-effectively through the use of resources to operate the process.

The patient sees the quality of medical care as service received by the physician they trust and chooses based on transparent, informative interaction that meets both patient and doctor’s realistic expectations. Finally, the physician’s perspective of quality healthcare points to a grey zone. That means; Quality measurement has not yet been fully adopted by the medical profession, despite its essential role in improvement activities. One of many reasons for physician’s stance is their distrust of the system and skepticism of the healthcare industry. The task of advising one’s practice and using that information to make improvements should be a needed skill and a wanted responsibility. Physicians are still watchful of making the quality of their care transparent, but data must be measured and shared if the quality is to be rewarded. But today, due to the physicians’ passivity, the task of medical service quality measures has fallen in the administrators’ hands. This has created a vicious circle of wrong quality standards, patient and physician dissatisfaction, high cost, and corporate profit. Ultimately, the medical profession must take leadership to make care more transparent. Physicians must be able to balance issues of ethics, fairness, accountability, and confidentiality.

The public is becoming increasingly concerned that they do not receive quality healthcare service and start comparing the systems, countries, and political ideologies. But digging deep, most feel healthcare coverage is synonymous with better quality medical care. But once we take all that we discussed in this article; we can narrow down the answer to the question to one solution. It depends on what you expect from the healthcare system. If you desire immediate and timely care at the lowest cost or a government system of delivery, it probably doesn’t exist. If you want government-run universal coverage, you might get ready to accept minimal medical care at third party discretion.