Up Front | Mar 2015

The Quality Conundrum

Having happy and satisfied patients is the key to a successful practice. Getting there, however, is challenging, and the learning curve to accomplishing this is steep and not taught in medical school or postgraduate training. There are many parameters that contribute to making patients happy, including obtaining great outcomes, offering high-quality value, and providing good customer service. One area that I believe is taken for granted in many practices is quality of care.

I am certain all of you believe that you provide high-quality care to your patients—but do you?

Much depends on how quality is defined. When asked about quality, most doctors will likely come up with a variety of parameters, some of which are emotional and fluffy. This is probably because quality is something that they have never conceptualized—as was previously the case with me, too. Although undoubtedly a variety of parameters can be used to define quality, for purposes of comparison it is best to create some consensus on the definition and its influencing parameters.

During my process of researching quality, I came across information from the Institute of Medicine ( This nonprofit body is the health arm of the US National Academy of Sciences, and it provides advice to government and private organizations to assist decision-making about various aspects of health care. A working group has cleverly broken down the issue of quality into six main goals,1 which, at first glance, may seem obvious (see Six Goals for Ascertaining Quality).

It is worth taking a moment to evaluate your own model of health care delivery against the six goals outlined below. Go further and look at other rival models of care, such as the UK National Health Service, corporate organizations, and group and solo practices, and see how they score against each parameter. I am certain you will find the process enlightening.

I went through this exercise for a variety of providers, and the conclusion I came to is this: When delivery excels in one parameter, there often seems to be a level of compromise in another. An organization that is super-efficient and not wasteful might be less patient-centered and, in turn, there may be compromises in safety. On the other hand, considerable focus on safety and patient-centeredness may be more costly and thus less efficient.

This then raises the question: Can a perfect score be met on all parameters? As an eternal optimist, I believe the answer is yes. However, accomplishing a perfect score requires considerable organizational planning and coordination. Like many large projects, this can only be accomplished in small steps. A good start would be to embed the six goals outlined below into the value system of one's practice or organization.

Ultimately, it is up to us individually to decide what we are most comfortable with and to continue to strive to provide high-quality care. The process is iterative and involves constant reevaluation of our model of health care delivery against the parameters proposed by the Institute of Medicine. Making progress will undoubtedly enhance our practices and increase the numbers of happy and satisfied patients. n

Sheraz M. Daya, MD, FACP, FACS, FRCS(Ed), FRCOphth

Chief Medical Editor

1. Institute of Medicine of the National Academies. Crossing the Quality Chasm: The IOM Health Care Quality Initiative. Accessed March 3, 2015.