Capturing the true meaning of quality in healthcare

Capturing the true meaning of quality in healthcare

Research shows that despite frequent assessments, much is unknown about the quality of local health and care services.

Everyone wants quality healthcare, but what exactly is quality and how do you measure it?

Does it have to do with the wait time for home care services? Or how many nursing home residents had medical supervision in the past year? Or whether the medication lists have been recently checked?

"These are important aspects, all of which are worth monitoring. The problem is that the quality cannot be easily reduced to a quantifiable value," said Randi Olsson Haave, assistant professor and doctoral candidate at the Norwegian University of Science and Technology (NTNU) in Gjøvik.

“See me as a person”

Haave is in the process of completing a doctorate on quality in municipal health and care services in Norway and the methods used for monitoring.

“What particularly stands out in my research is how much is seen and treated as influencing a person's experience of quality,” she explained.

Or as a nursing home resident put it in one of Haave's research interviews:

"Please, pet [caregiver] come in stressed, it makes me ten times more stressed. I immediately feel my oxygen intake drop. There's something about a person seeing you, the energy they give you. It means so much when you have breathing problems like I do."

Haave explains that many of the users and residents she interviewed emphasized the importance of interpersonal relationships.

"It could be employees who were good at getting their attention and creating good moments, or employees who were open and understanding. These moments helped them feel safe and cope with everyday life," the researcher said.

A resident Haave was founded with a type of medicine:

"There are some [caregivers] here who are like rays of sunshine. It's like you get a magic pill every time they walk through the door."

Much is unknown about quality

The starting point for Haave's research is that much is unknown about the quality of community health and care services. This is despite the fact that municipalities have been required to report annually to national authorities on 32 different quality indicators for over ten years.

"On the one hand, there is broad agreement that we need good ways to monitor the quality of health services. On the other hand, the question is how best to do it," said Haave.

Quality indicators are currently used. According to the Norwegian Directorate of Health, a quality indicator is an indirect measurement, a pointer that says something about the quality of the area being measured.

“An example of quality indicators in urban health and care services could be the time spent from a decision about home care services to the users receiving the service,” explained Haave.

Still a lot of uncertainty

Haave explains that quality indicators are intended to contribute to transparency regarding the quality of the services provided.

"The results are intended to provide authorities with a basis for prioritization and should serve as a starting point for improvement work both nationally and locally. They are also intended to provide residents, users and relatives with information about the quality of services," said Haave.

"There is still a lot of uncertainty about the results at both the local and national levels at this time. This is due to a combination of municipal mergers and different registration practices," Haave said

As noted, Haave's research also highlights a gap between quality indicators related to healthcare and those that describe those receiving care as good care.

Residents, users and relatives should be heard

Far too little is known about how those who receive care and treatment receive itExperienceher, says Haave.

"None of the quality indicators used today measure the experience or satisfaction with the care provided. Municipalities need to gather this knowledge by asking residents, users and their relatives," said Haave.

Unfortunately, it turns out that many years can pass between each time communities collect this type of feedback, and when they do, it is often through questionnaires that must be submitted either by mail or electronically.

"There are a lot of people who just can't do this. Many need help answering these questionnaires, and as a result the response rate is low," Haave said.

She believes that Norway needs to make greater use of other methods to document the quality of municipal health and care services.

Greater focus on the actual experiences of care

Although the methods used to monitor the quality of health and care services have problematic blind spots, Haave does not believe the solution is to get rid of them.

The nurses and healthcare professionals I interviewed want us to continue using quality indicators. They say the indicators provide them with important frameworks and goals. But they also emphasize that the indicators provide a sufficiently accurate picture of the quality of the services they provide,” said Haave.

Your recommendation is therefore clear:

"More focus needs to be placed on what the indicators do not currently measure, namely the actual experience of treatment and care. To achieve this, we also need to develop and use other methods to document quality."

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