The Canadian public health care sector is freely accessible to all citizens, and although access to health care facilities and services can be limited in some remote, rural parts of the country, most Canadians are able to access general care on a regular, or as-needed basis. However, is access to health care services alone sufficient for delivering better patient outcomes?
ACCESS ALONE ISN’T ENOUGH—CHANGE THE WORDING
After persistently high rates of maternal mortality, India initiated a cash-transfer program in 2005 where women were paid to deliver their babies in health care institutions, in hopes that this would alleviate the problem. Unfortunately, despite increased rates of institutionalized births, the program did not have a detectable effect on maternal mortality rates.
This scenario sheds light on the fact that access alone is insufficient in ensuring improved patient outcomes. Instead, focusing efforts on improving the quality of care given to patients makes more of a lasting and substantial impact towards positive health outcomes.
WHAT IS QUALITY CARE?
According to the Institute of Medicine, high-quality patient care is described as having six key features:
The first three descriptors stand as the top contributors to care quality, as they most directly affect patient outcomes. A study by the World Health Organization (WHO) found that approximately 43 million injuries reported annually can be attributed to an in-hospital acquired adverse event (AE). Safety is the pre-eminent measure of care quality. Additionally, though the mission of clinicians is to “do no harm”, not all treatments are created equal. Ensuring that the care a patient receives is actually effective in improving their health outcomes is absolutely critical when asserting the quality of care you deliver, and must be based on the latest clinical evidence. Lastly, high quality care must be patient-centered. Patients aren’t likely to return to particular clinicians if they don’t receive treatment and care that upholds their dignity, and encourages they autonomy and active participation in their own health.
PERFORMANCE MEASUREMENT TO IMPROVE QUALITY
Quality improvement initiatives must begin with robust and meticulous data collection. Firstly, to obtain an accurate understanding of an institution current metrics and outcomes. Using comprehensive, technological tools that measure and track ordering behaviours, patient outcomes, test results, and gather other clinical information, clinicians and hospital administration capture the data they need, distribute it as necessary, and subsequently use that data to inform policy and operational changes. Solutions that display clinician activity across an institution and regional health network create an environment of accountability and evidence with which to design and implement quality improvement initiatives that benefit clinicians, allied health care professionals, as well as patients. The purpose of these tools should be to improve clinical workflow efficiencies for care providers, and also to enhance the quality of patient care according to the six features determined by the Institute of Medicine.
Improving patient outcomes is about more than just access to care, but ensuring that the care that is giving is of the highest quality. Improving quality of care, then, should be the highest priority for health care officials and providers, and begins with transparent and comprehensive data capture, tracking, and reporting.
Randive, B, Diwan V, De Costa A. India’s conditional cash transfer programme (the JSY) to promote institutional birth: is there an association between institutional birth proportion and maternal mortality? PLoS One 2013;8:e67452
Jamison DT, Summers LH, Alleyne G. et al. Global health 2035: a world converging within a generation. Lancet 2013;382:1898-1955