Getting Healthcare Quality Right – Part 1

By Ajibike Oyewumi, Healthcare Quality Specialist, IFC Healthcare Quality Advisory

Poor quality healthcare services are a huge problem all over the world and this has been recognized as a development challenge. In 2015, the United Nations included in the Sustainable Development Goals (SDGs) a commitment to achieving universal health coverage by 2030 “so that all people and communities receive the quality services they need.” To achieve this SDG, all countries, and the healthcare providers within them, need to commit to delivering quality care.

The question then is how should this be done? In this two-part blog series, we will show how. This first part looks at why quality is so important and what a culture of quality in a healthcare organization looks like. The second blog will look at four practical buildings blocks for a culture of quality in a healthcare organization including leadership, structure, people and training, and measurement.

Firstly, why is quality important? The World Health Organization estimates that during the roughly 421 million hospitalizations that take place in the world every year, one in ten patients suffer from adverse events. These are injuries related to medical management, rather than complications from disease. These injuries can often be avoided. One study across 26 low- and middle-income countries, found that 83 percent of adverse events could have been prevented and some 30 percent of these led to death.

Other statistics make grim reading. In 2018, a study of 137 low- and middle-income countries, published in The Lancet1, found 8.6 million excess deaths because of poor healthcare in 2016. Of these, five million were estimated to be due to poor-quality care received. Poor quality of healthcare is a major driver of excess mortality across all conditions, both non-communicable and communicable.

Poor quality is also very costly for the patient, their families, and healthcare organisations. For the patient, the cost of poor quality includes the cost of additional hospitalization, cost of living with chronic ill health and permanent disability. This results in lost earnings for the affected patients and their families. In addition, there is the psychological cost to the patients and their families associated with losing a loved one or coping with permanent disability. Though this may not be measurable in financial terms, it is significant. Costs to the organisation include additional spending on direct medical costs, litigation costs, loss of reputation and credibility, loss of clients and market share.

Ensuring the delivery of quality care is therefore vital to avoid needless pain, loss of lives and financial loss.

Building a Culture of Quality

To have a chance of reducing these numbers and achieve the SDGs, healthcare professionals around the world need to find ways to improve patient safety. Quality is as much a cultural expression as a process. A true culture of quality is one where employees follow quality guidelines and consistently see others taking quality-focused actions. They hear others talking about quality, feel quality all around them and they make quality part of everyday habits in the operations of their medical facility.

The culture of an organization is the embodiment of its core values. And quality needs to become a core value. Culture drives the policies, practices and processes used to accomplish an organization’s work. It matures over many years as norms are passed from one generation of staff to the next. Shifting an organization’s culture along the quality continuum requires commitment and deliberate management.

When a quality culture is achieved, all employees, from senior leadership to frontline staff, incorporate quality and safety into their daily work. Employees continuously consider how processes and outcomes can be improved, and quality is no longer seen as an additional task but as an essential pillar of their job.

So, what does a culture of quality look like in real life? It is an environment where people at all levels of the organization genuinely care about the quality of their work, striving and making decisions to achieve quality for the sake of delivering quality to the customer (which is most often the patient). It is not just for the sake of profits or to meet compliance requirements. It includes staff working as a team at the unit level and the broader organizational level to achieve the common goal of delivering the best possible quality of care and services to the patients, their families, and all other customers. It also includes reporting incidents and adverse events because of a genuine interest in improving the organization where they work and where they feel psychologically safe to do so. Leaders in this environment deliberately focus on the incidents reported for the purpose of learning and action rather than blame. Such leaders provide feedback to their staff in a transparent manner and convert a mistake into stronger performance. Let your last mistake be your best teacher. That is the essence of quality culture. As Winston Churchill once said: ‘All men make mistakes, but only wise men learn from their mistakes’.

In the next blog we will look at the practical steps medical organizations can take to put this culture of quality into action, and, crucially, make a success of it.

1.     https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31668-4/fulltext

This blog has been prepared as part of IFC IQ Healthcare Advisory activities that helps healthcare service providers around the world improve patient safety, align practices with global quality standards, and build safe health infrastructure. For more information, please visit www.ifc.org/iqhealth