Quality is in the eye of the beholder: A patient-centered approach

November 5, 2018 | Patient care

CONTRIBUTOR

Laura Mueller

Essential Insights contributor, healthcare writer

Featured expert

Bruce Vanderhoff, MD, MBA

Chief Medical Officer, OhioHealth

What is quality healthcare? It's a question that may have a different answer depending on who you ask. It's also a question that has gained significant importance in the era of value-based, patient-centered care.

Figuring out how to provide the highest quality care is a goal of healthcare providers across the globe. Although defining what quality care looks like is usually left to individual health systems.

In recognition of the recent Healthcare Quality Week, Essential Insights contributor Laura Mueller spoke to Bruce Vanderhoff, MD, MBA, chief medical officer at OhioHealth, to learn how one system takes a patient-centered approach to healthcare quality.

Mueller: What does “quality" typically mean for providers?

Vanderhoff: It used to mean that I as a physician was the best technician or best diagnostician, especially in the eyes of my peers. But increasingly, our definition of what quality means comes from our patients’ point of view. It's no longer enough to be the most skilled technician or the best diagnostician—we need to be providing our patients with the opportunity to have the best quality of life. That means that we have to work with patients on more than a cure.

Mueller: Do you think the way providers are now looking at quality is the way patients have always looked at it?

Vanderhoff: Over the last decade, patients and providers have been on a journey of discovering this new view of quality—quality through the eyes of patients and their quality of life. And I think today, these views are increasingly similar. Our providers are focused on what their patients want and need, rather than just what we think is best for them. We really have adopted this view that our patients' sense of well-being is at the core of our sense of gratification in our work.

Mueller: Do you think there are still distinctions between how providers view quality and how patients view quality?

Vanderhoff: Providers are trained as practical scientists. As a result, there's still a tendency to skew toward intervention and curative care as the hallmarks of delivering the best care. Patients are becoming much more holistic in thinking about their care, because ultimately, they want the quality of their lives to be the best they possibly can be. They want more than just what science can bring to the table, and I think that's been the evolution in thinking that providers have accepted and moved toward.

We want to be the best clinicians, we want to be able to provide our patients with the latest and greatest in curative care, and we want to go beyond that to create a caring experience and a caring and healing environment.

Mueller: How do patient-reported outcomes factor into quality?

Vanderhoff: Knowing that patients feel we've done a good job is very important to us. And there are a variety of ways that we seek to understand whether we're meeting their goals and expectations. One example from OhioHealth is that we have put patient and family advisory councils into place. These councils are expressly designed to help us both communicate with our patients better and create a more healing environment for them when they seek care.

One of the most interesting evolutions of that work is that it's now gone beyond helping us better understand the care of our patients to helping us address issues of physician and provider burnout. Patients’ insights about how we can serve them better also help our physicians and providers derive more joy and satisfaction from the work they do. We look at those patient reports of their outcomes and care as a gift. This is valuable information that helps us be better care providers.

Mueller: What are some quality initiatives that all providers need to be aware of?

Vanderhoff: The challenge right now is there are a dizzying array of quality score cards for reporting initiatives. All of them tell a part of the story, but none of them tell the story completely. We've had to look at the communities we serve and discern which of those reporting initiatives seem to be of greatest interest to them. Currently, we're broadly focused primarily on those that come from the Centers for Medicare & Medicaid Services (CMS), including some of the MACRA/MIPS reporting frameworks, as well as Leapfrog's Safety Ratings.

These score cards are really intended to provide the public with information about the overall quality of the healthcare that organizations and providers bring to communities. But how we actually move the needle is with healthcare providers relentlessly seeking opportunities for improvement. I see that every day inside of our health system, and I would hope that we're seeing that inside other health systems too.

Mueller: So, it's really about picking and choosing the quality initiatives that make the most sense to your patient population and the care that you're offering?

Vanderhoff: Our mission is to improve the health of those we serve—a mission that I'm willing to bet is a very similar mission in many other health systems. If that is our mission, how do we look at the numbers that we find in our population, the science that's emerging that's pertinent to our population, and take our care to the next level?

We should use the reported quality information to identify opportunities to improve our patients' experience and then continuously and rigorously apply what we learn to improve healthcare. Let’s look at the information in these quality initiatives to help us raise the bar, rather than looking at that information as some static illustration of the truth about quality. Because unfortunately, as well-intended as these metrics are, none of them are ever going to be able to tell the whole story.