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The Quality Myth:
Complying with best practices or standards, national or international, is a good start to build a foundation for a safe and standardized care. However, this is not how it’s being handled or at least viewed in many healthcare organizations, let alone that meeting standards does NOT guarantee positive results or outcomes of care, according to many experts.
Many organization mistake complying with “accreditation” standards with the notion of achieving the right level of quality and safe care. In fact, doing that may actually jeopardize safety and quality of care by settling with minimum requirements, adopting a very rigid view point, or focusing on documentation rather than sustainable changes in actual practices. And because of that, no rooms is left for creative problem solving or daily continuous improvement. Staff in such organizations, using their own words, have become robots memorizing and following a set of external standards, often without even knowing the rationale behind them. And when a situation arises that call for innovative solutions or new ideas, they seldom step up, much like a linear school system based on fixed subjects evaluated by final exam results only. So, instead of investing on people to lead and improve quality and safety, those hospitals have created disengaged and uninterested work force that get real hype only by signing the final box on a piece of paper.
Decision makers in healthcare organization need to understand clearly that writing a policy or adding a checklist does not guarantee good results in real patient care. They need to ask the questions: what is a “good” outcome of care they aspire to provide to their patients, and how does complying with the same standard over and over again achieve that?.
I recall looking at one Linkedin post by a very famous hospital group in India. The post advertises the attainment of accreditation by the JCI, and states that it has achieved the most prestigious excellence award in healthcare in the world. I’m not sure if JCI accreditation (or any accreditation for that matter) can be considered an excellence award, and I can’t recall JCI referring to that itself!
The problem with many healthcare organizations seeking international or even national accreditation is that their main goal, is to market their services and acquire more patients, and hence more business, or to satisfy regulatory requirements. This is well known among those close to the decision making and strategic planning (assuming there is proper strategic planning).
One of the private hospitals I know which somehow succeeded in achieving multiple international accreditation, mentions in its documents that they support a continuous improvement culture through complying with accreditation standards. Not only this is a flawed understanding of what continuous improvement is, but when you ask the concerned staff about the standards they were accredited for, and are expected to apply in their daily work, you only get blank faces!
I’ve had the chance to come across a number of healthcare organizations, both governmental and private, that have obtained different accreditation status, and yet are notorious among their own staff, let alone the consumers of their services, as providers of poor quality and less compassionate care. This alone indicates without much doubt that obtaining accreditation is in most cases merely a certificate on the wall that has no real impact on the system of care.
The accrediting and regulatory bodies do also play a role in this misconception and malpractice. They need to revisit their strategies, and the criteria used in the evaluation of quality and safety in any healthcare organization, and how big is the value of granting accreditation for the communities served.
The IOM landmark report “Crossing the Quality Chasm” 15 years ago showed that healthcare systems were broken, misaligned, and fragmented. Sadly, the same problems still exist today, and the number of patients suffering from medical errors and poor quality of care are on the rise despite all the advances on the medical field and the efforts to improve quality and safety.
On the brighter side, there are some great examples around the world of healthcare organizations who succeeded somehow in pinpointing reasons of many common issues, whether it’s lack of vision and leadership, rising costs, miscommunication, medical errors, wasted time and energy on things that adds no value, patient dissatisfaction, demotivated or burnt-out workforce, to mention a few. Also, many countermeasures were put in place to overcome those issues with surprising results.
Some organizations adopted lean healthcare and continuous improvement as their everyday philosophy with a great deal of success, setting an example and paving the way for other healthcare organizations to follow or at least look critically at how they view quality and safety of care, and what they really need to change.
to be continued...
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