What Does Quality Healthcare Mean?

A few weeks ago I virtually attended the NCQA Quality talks. The goal of the talks is to hear from experts in a variety of areas of healthcare as they consider what quality healthcare means.

This year the talks focused predominantly on marginalized communities and challenging situations. While Covid is a daily reminder of the lack of healthcare resources for marginalized communities, the division was already there. Covid did not create it. It just exposed it.

So what does quality care look like? Two talks were particularly impactful for me.

The Opioid Epidemic

One of the first talks of the day was by Travis Rieder, author of “In Pain: A Bioethicist’s Personal Struggle with Opioids.” Rieder shared his personal story. He told us how he was in pain after multiple surgeries, and how he first requested and then insisted on more pain medication. He shared how, once he had the medication (it was opioids), he was not advised on how to stop taking it – and when he did stop taking the opioids, he went into withdrawal and came close to giving up.

Rieder made a few good points. One – perhaps the obvious one – is about how opioids are prescribed. Opioids are prescribed with much the same instructions as antibiotics: take X amount for Y amount of time. Yet one of these is addictive, and the other is not. The addictive one requires careful tapering.

Another point he made is less obvious. The problem here was not simply that Rieder was prescribed opioids. In fact, initially he was not prescribed opioids. The doctors refused to give him additional pain medication. The problem is threefold:

• Pain management is not well enough understood, and so he was initially under prescribed pain medication
• He was treated as an addict when he asked for more, until he used his white privilege to demand to (more or less) speak with a manager – and then he was over prescribed without a second thought
• When he received the medication it was not managed care

Quality care – when it comes to opioids – means managed care.

Racism

There’s another aspect to giving care, which Joia Creer Perry, President of the National Birth Equity Collaborative, spoke to in her talk. Perry spoke about the role of race in healthcare. She gave examples of rules that seem “normal” until you think about how they impact others.

For example, having one visitor and only one visitor allowed during birth may seem “normal”. But why is it the hospital’s role to determine that the mother can only have one visitor? Why can’t the mother be supported by her mother and sister? What if the father can’t find childcare?

Perry also spoke about race specifically. More than three times as many Black American mothers die within a year of childbirth as white mothers. And when we talk about this problem, we shouldn’t refer to it as a “race” problem – because it isn’t. This is a racism problem. Black American women are not more prone to death in or after childbirth. American racism makes it more difficult for Black American women to get healthcare. It makes it less likely that Black American women will be in a higher socioeconomic class.

Race is not a social determinant on its own. Racism causes social, political, and health-related problems.

Quality Healthcare Goes Beyond Service

When I think of “quality” I think of something well made. Like a nice cloth. It’s easy to think of “good quality” like manners, or good service. But quality healthcare doesn’t mean polite healthcare. It means caring healthcare.

I love Sir William Osler’s quote:

The good physician treats the disease; the great physician treats the patient who has the disease.

Sir William Osler

Quality healthcare is about understanding people holistically. To offer true quality, we need to respect people. We need to treat all cultures and all races and all genders. Most of all, we need to improve our system to treat people, not diseases.