Health Care Quality
The last major health care problem that requires immediate attention is the quality of health services received by many Americans. According to Schimpff (2012), although we spend 50 percent more on health care services than the next closest developed country, the quality of our health care is subpar and medical errors are epidemic. Torinus (2010) argues that there is no proven relationship between the price of health care services and the quality of those health services. In fact the opposite often seems to be the case, with lower price quite often indicating efficiency in production along with improved quality. That is, by producing large quantities of goods and services, a company or institution not only achieves economies of scale allowing it to lower prices, but it also becomes more productive in its processes, which allows it to actually improve quality.
Torinus (2010) further argues that although quality in health care is not what it should be in the United States, it can be improved if the country is willing to put in the necessary time and effort. Quality improvement can reduce costs, improve access, and improve health outcomes.
Another key indicator of diminished quality in the delivery of health care services is the rate of medical errors, errors that have become epidemic in the United States over the last decade. The Institute of Medicine (IOM) defines a medical error as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” Medical errors typically occur in operating rooms, emergency departments, and intensive care units. There is mounting evidence that entering the medical care system at any location increases a person's risk of adverse drug events, errors in care delivery, and the development of hospital-acquired infections. Such errors are increasing the cost of health care delivery, requiring longer hospital stays, and causing disability, death, and a loss of trust in medical care. In fact the CDC now classifies medical errors as the eighth leading cause of death in the United States.
The failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.
In 1999, the IOM released a study revealing that as many as 98,000 of the 33 million individuals hospitalized each year die and many more hospitalized patients receive secondary infections or incur other problems because of poor quality health care while hospitalized. According to Black and Miller (2008), the percentage of hospital admissions experiencing injury or death is between 2.9 and 3.7 percent. Ironically, many of the costs associated with medical errors are actually reimbursed by patients' insurance companies.
Health care services are produced and delivered by people, and the improvement process must begin and end with these people. According to Black and Miller (2008), the solution to problems in delivering health care services will be found in the skills and ideas of the people who do the work of delivering health care services to patients. These service providers control the creative power so necessary for success in problem resolution. Unfortunately, health care institutions often pay little attention to these individuals. This lack of attention to medical errors will need to change as the health care system undergoes reform.
Because health care services are produced as needed rather than ahead of demand, they need to be produced error free each time. This makes medical error a systems problem. When a mistake is made in the delivery of a service, it is too late to correct the faulty delivery. It is very important, therefore, that systems be designed to prevent errors in the delivery of health care services before they are delivered. When mistakes are made, they must be evaluated and corrected immediately in order to prevent future occurrences. The results of this evaluation then need to be shared with all employees in order to prevent future problems.
In order to deal with these new demands, health care providers are beginning to realize that they are obligated to spend time focusing on delivering quality care and providing exceptional service to their customers. This will require employees who understand that it is the consumer who ultimately determines their success or failure as health care providers and also the success or failure of the health care system. Baldoni (2012) also points out that the key to pleasing the consumer is for employees to understand their purpose. This means that health care employees must be in tune with the wants and needs of their consumers.
The health care delivery system that was once the best in the world is in a crisis situation that threatens its very survival. The major health care problems causing this crisis revolve around escalating costs for health care services and poor access to and outcomes from the very services that are supposed to improve our health. The entire system of health care found in the United States is in need of tremendous reform. Our health care system seems to be plagued with high costs, access problems for many, and health levels lower than those in many other industrialized countries. Making matters worse, the United States is facing an epidemic of incurable chronic diseases and an epidemic of preventable medical errors.
Several countries offer all their citizens health care services that are less expensive than services in the United States and that result in improved health indices for these countries' entire populations. The critics of these health systems argue that they ration health care and that is why their costs are so much lower than costs in the United States. If that is the case, perhaps rationing some care may make sense if it improves health at the same time. As the United States moves through health care reform, it is very important that we look at how these countries deliver their health care and determine whether some of their approaches can be helpful to the United States.
Health care services delivery in the United States is going to change in a dramatic way in the next several years. This change is going to involve every health care organization and every person who works in the field of health services delivery. The new health care system that evolves from the change process is going to focus on health outcomes that can be produced at a price that everyone involved can afford.
comparative effectiveness research (CER)
evidence-based medicine (EBM)
general access issues
Patient Protection and Affordable
Care Act of 2010 (ACA)
special access issues