Archipelago Healthcare – Better Healthcare in Mind

I would make the following observations about measures and stimulating high quality, low cost operations:

Flow

Measures that describe flow through the system such as length of stay (provided they are clearly defined and interpreted) are most likely to encourage frontline staff to eliminate costly sources of failure and waste which themselves detract from high quality care.
Flow measures such as these must be applied at every stage in the patient’s journey (they are typically thought of in respect of inpatient stays, but flow in relation to CMHT caseload is just as crucial).

Clinical / Holistic Outcome

These measures of flow must be tempered however, otherwise the net result is that patients are progressed too fast and maybe put at risk or at best simply re-access the system.
The patient’s progress should only be held up if the patient is too ill, or too ill equipped in terms of the skills needed to resume an independent life in the community (not, as is commonly the case, due to other system failures or failures of synchronisation of inputs).
The rightful brake on flow, in my view, is the application of appropriate clinical measures and other holistic assessment measures that can help us to guage objectively if the patient is sufficiently recovered to progress (in other words reached a quality standard sufficient for referring to the next service).

Patient Value Patient Experience

Finally and ultimately patient experience measures captured by surveys that are bespoke, locally derived and relate to the service in question are essential. It is these that when analysed have the potential to encourage staff to entwine good clinical care with good service. One just has to look at the average clutch of complaints to see how it is poor service rather than poor clinical care that undermines the journey to wellness.

Discovery by inductive reasoning …some things defy measurement!

I believe that the presence of significant proportions of the true quality we seek can only be accounted for by a process of ‘inductive’ rather than ‘deductive’ thinking. In other words.. presence of quality is ‘induced’ rather than ‘deduced. Only inductive thinking will reveal quality because quality is in fact to a large extent the absence of ‘things that harm the system’ (the absence of unnecessary constraints on freedoms to serve the patient, the absence of failure, the absence of waste …all these things are difficult to measure).

When we attempt to ‘deduce’ quality only through the measurement of things that we can see and touch (the presence of a care plan say), we run the risk of creating another target that results in the wrong behaviours (the perfect and comprehensive auditing of countless potentially low quality care plans, rather than the delivery of well planned care).

Too many targets arrived at by deduction also soak up much needed staff capacity, capacity that could be used to produce more frontline oriented measures to which staff can really relate to and which give them encouragement in their work. Look after the patient and the targets will look after themeselves.

Stefan Mieczkowski