Long-time cardiothoracic surgeon and current President of ISQua discusses clinician-patient interactions and defining quality of care
“Pushing a trolley down the corridor, feeding a patient, administering a pill, or doing an operation - all of these activities relate to the patient.”
Cliff Hughes, president of the International Society for Quality and Health Care (ISQua) and a senior advisor in Patient Safety at Guy’s & St Thomas Trust in London UK, spoke to Salzburg Global during the session Better Health Care: How do we learn about improvement? about the importance of patient interaction in improving health care.
“We need to recognize that everyone in the health care system ultimately interacts with the patient.”
Hughes has played two important roles in improvement: direct patient care provider and evaluator. As a cardiothoracic surgeon in Sydney for 35 years, Hughes believes that quality of care is built upon direct engagement with patients in order to fully understand the challenges they face. He says, “The whole reason I was at work was for the benefit of the patient and their family. I think that can get lost in the translation, particularly for people that are coming to what is essentially a bureaucracy and might not get a chance to talk to the people who are delivering the care. I think there are two solutions to that problem. One, is that the people delivering the care have to talk to the managers and secondly, the managers have to walk around the wards and see what really happens. Or walk around villages and see what problems emerge from lack of safe water, or proper sewage or any natal care.”
“If we don’t actually interact with the patients, we miss all of that, wherever we happen to practice.”
In providing care and later evaluating areas in which it can be improved, Hughes says that it is important to first recognize that quality is often defined differently by caregivers and patients; “interestingly, if you ask doctors and nurses about what is happening in their hospitals, they focus on safety, when things go wrong and patients get harmed. However, if you ask patients, it is about quality, which is the experience they went through even though they might have been sick or even facing death.”
There are multitude of other factors besides the patient-clinican interaction that impact care. Hughes explains that care is also effected by the patient’s family and surrounding staff, as well as the pressures placed on the health care system itself, from the perceived needs of the ministries of health to the funding obstacles of treasury departments.
“Compassion is central, because it means having a respect for and with the patients, the people that we are trying to serve, and it also means having a respect for and with the staff that we work with;” which translates into recognizing these external pressures, but compassionately working to provide the best care possible.
Noting that the quality improvement movement has grown dramatically since the inception of ISQua over 30 years ago, Hughes sees value in the growth of understanding around defining quality improvement. “One of the roles of our organization, is to act as a broker for some of that information and education while doing implementation work. I think that this seminar is starting to build a framework around the science of quality improvement, there has been a science for many years, but the rigor around the scientific endeavor in an academic sense or around products like drugs or devices is very different than the science around quality improvement. Quality is actually defined best by the patient experience, so it is a personal and subjective approach to doing things in better way.”
