Three Personal Stories on Quality

Bruce Siegel

Research Professor, George Washigton University School of Public Health and Health Services Program
Program Director of the Expecting Success program

We often talk about quality in a very abstract way. For me, quality health care is a sense of security that you’re going to get the care you need at the right time in the right place. It’s a knowledge that there’s going to be a team of people who will be sensitive to what you need, who can understand your concerns, and who will put in the time and effort to make sure everything is done in the best possible way to heal you, cure you, or at least relieve your pain.

About a year ago I had an experience that really opened my eyes to quality and what it does and doesn’t mean. My 91-year-old mother was found confused and was taken to the hospital. My mother’s an immigrant from Haiti, so she speaks Creole–she speaks English also, but as part of her confusion she was speaking only Creole. The doctors ran a lot of tests and finally decided they really didn’t know what was wrong with her; therefore it must be something psychological or psychiatric. After two weeks of my mother being hospitalized, another physician came onto her case and asked, could there be something else going on here? This physician did more tests and found that she had a blood infection. Her condition was cured within weeks after being given intravenous antibiotics.

It was a story that spoke to me in a lot of ways. It spoke to the gaps in the system and it spoke to the biases and expectations that many of us, including physicians, bring to our encounters with patients. We have to get beyond that if we’re going to provide quality health care.

Taking a regional approach to improving quality makes a lot of sense. Americans don’t get health care nationally; they get health care down the street. They get it in their community. Also, patients go between various parts of the health system: doctor’s offices, clinics, emergency rooms and hospitals, nursing homes. If the various parts are not on the same page in a region really bad things can happen. For instance, a patient leaves a hospital, they have a heart problem, and the information that people got about that patient while they’re in the hospital doesn’t follow that patient to the doctor’s office or to the clinic. That can hurt; that can hurt real bad.

Patients don’t know much about quality health care in America. They have a feeling about whether or not a doctor or nurse spends time with them and is responsive to them. But so many times I’ve seen patients who love their doctors even though that doctor really isn’t practicing up-to-date medicine. People need to know that we now have ways of measuring how good doctors, hospitals, nursing homes, and other parts of our system are. They need to know that this information exists and to be empowered to use it. I think that’s going to be a major agenda for quality over the next decade. Measuring quality and publishing reports about it.

Anne Snowden

Director of Quality Reporting
Minnesota Community Measurement
Aligning Forces for Quality Grantee

I work for an organization that makes quality ratings on clinics publicly available so that consumers can make better informed choices regarding their health, and will ultimately improve health care quality. Public reporting is about recognizing medical groups and clinics that are doing well in health care and providing motivation for those who need it.

I have a great story that reflects why public reporting matters. I attended a recognition reception for medical groups in Minnesota that were top performers in our measures. There I met a nurse practitioner who expressed appreciation that our organization had added a Cancer Screening composite measure to our Web site—it measures the percentage of patients ages 50–80 who received all appropriate cancer screenings (breast, cervical and colorectal). She knew that results would be reported publicly and that their medical group would be compared to their peers. She said that this motivated her clinic leadership to add this measure to their internal goals. By doing so, they put systems in place such as reminders for physicians, patients and clinic staff to make sure their patients got all these cancer screenings.

She then told me about one of her patients who came in for a mammogram and they found an early stage breast cancer. This nurse practitioner was convinced that this patient would not have come in for a mammogram had the reminders not been sent. Her breast cancer was caught early enough that it made a difference.

You don’t get to hear these stories every day. You don’t hear that public reporting actually saved somebody’s life. I’m grateful she shared this story with me and that she took the time to let me know that the work we’re doing matters. Now I know that it mattered to one person. And I would guess that if it helped one person, it probably has helped many more. I’m so pleased with what we do. I really believe in it.

Ashish Jha

Practicing Internist and Faculty Member at the Harvard School of Public Health in Boston

Disparities in health care are particularly troubling. We know from the countless studies that have been done that blacks, whites, Hispanics, other groups receive very different health care. And even if we account for differences in access, insurance and income, we’re still left with a pretty substantial gap in the care that people receive. As a practicing physician, I think I treat everybody the same. Well, guess what? Every doctor thinks that. And yet, somehow, when it comes to the actual delivery of care, our health care system ends up treating people very differently based on their race or ethnicity. I find that very troubling and it motivates me to understand why people get different care and how we can fix it.

A patient that had a profound influence on me was an elderly African-American gentleman I cared for during my residency. He had had an impressive career as a civil rights activist, had marched in Selma, and done terrific things in terms of advancing the civil rights agenda. And I had the honor of caring for him when he was very ill from metastatic lung cancer.

I worked tirelessly to keep his pain and nausea under control, to keep him out of the hospital so he could spend time with his wife and kids. I remember marshalling every resource I could, consulting all of my senior faculty, and yet, I felt like I was fighting a losing battle because I just wasn’t able to care for him in a way I knew he deserved. He would get seen in the middle of the night in an emergency room, and no one would contact me. He would get seen by other doctors who wouldn’t prescribe him pain medicines because they were worried he might become addicted. It was tragic.

It made me wonder how we, as a community, could do better. There were so many troubling things along the way, the way he was treated by others, by the system, that made me wonder if it was particularly more difficult because he was African American. And I think this experience really shaped me to think much harder about quality, pay more attention to inequities, and try to understand how these two things are connected. I know we can do better for the sick and vulnerable members of our society, regardless of their background or skin color. We need to ensure that patients, like the one I mentioned above, get the care they deserve.