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Quality in the Health Care Marketplace

Corporations have imposed their own meanings on the word quality. They have misused the term in order to deceive themselves and their customers. Had they used a better word with clearly defined meanings then they might have been held accountable and much suffering may have been avoided.

Profit and Quality

In the marketplace profit competes directly with care for the available dollar and standards of care are consequently difficult to maintain. The greater the ambitions to "grow" or the greater the threat of bankruptcy the more "quality" is compromised. The story of marketplace medicine in the USA is a story of fraud and the failure to maintain "quality". There is also a fundamental concern about the way the health care market defines quality on its own terms. If a more precisely defined term was used then it there may have been some prospect of holding corporations accountable for care.

Measuring Quality - Tenet/NME
-- (to Tenet/NME pages)

Measuring Quality:- Tenet/NME documents reveal the interesting manner in which quality was measured and then understood. Staff went out to the psychiatric hospitals to assess the quality of services on a regular basis. Their reports describe the structure and organisation of each unit, the way it implemented corporate profit making practices and its success in meeting corporate objectives such as length of stay and profit per/patient day.

A paradigm shift:- In the company's reports this was called meeting or exceeding plan. The plan was developed centrally and each hospital was expected to meet or exceed it. Bonuses for meeting or exceeding plan were 50% of salary. Those who failed lost their jobs. This financial success in meeting plan was described in these reports as "quality care". The thinking was entirely financial. In corporate headquarters this "quality care" then underwent a paradigm shift without anyone challenging this. It was applied to the care received by patients and used in marketing.

Culture:- This was readily justified. Within the company profit was the measure of everything because "without it we would not be here". (quote is from memory). The fact that profits were made indicated that people valued it highly and were willing to pay for it. People would not pay for inferior care so it must be good. Unbelievably this was the level of intellectual activity and explanation within the company.

Outside Measurement of "Quality"

Tenet/NME:- All of Tenet/NME's specialty hospitals were accredited by the Joint Commission in the USA and by a psychiatric accreditation body. They were subject to state inspections and to oversight by insurance companies. I am not aware that Tenet/NME's boasting about the superior quality of its psychiatric care was ever challenged. Its own internal reports described the serious problems and the way in which care was compromised. -- (to Tenet/NME pages)

Aged Care:- Marketing, brochures and interviews with relatives promoted the high quality of care offered by nursing home corporations in the USA. Nursing homes are subject to extensive state and federal regulation, and to accreditation. Nothing happened to disturb this image of quality until an extremely angry group of Californian citizens collected death certificates and persuaded influential lobbyists that thousands were dying. A US senate inquiry was convened in 1997. Inquiries across the country since that time have uncovered an unbelievable cesspool. -- (to Aged Care pages)

Columbia/HCA:- Companies like Columbia/HCA, Sun Healthcare and many others also marketed the quality of care which they provided. Columbia/HCA obtained commendation in the accreditation of some of its hospitals and marketed this success. This was at about the same time as nurses were complaining bitterly about staffing problems. An independent evaluation showed that its hospitals performed poorly when compared with not for profit hospitals. The press reported allegations that some Columbia/HCA facilities gave false information to accreditation bodies in order to secure accreditation. There was some heated debate in the US congress about the failure of the accreditation process and the close relationship between accreditation bodies and the corporations. -- (to Columbia/HCA pages)

Defining Quality

The word quality is essentially a motivating and public relations word with rather ill defined positive associations and not a clearly defined meaning. It expressses an idea which we all identify with. It is something to aspire to and not something which you can measure. My dictionary uses words like "grade of goodness, excellence, high social status" to try to give it a defined meaning.

The market and market advocates do not distinguish the word quality from the very different word standard which is defined as a "basis for measurement" and a "criterion".

Quality consequently lends itself to creative use in the corporate interest as is so well illustrated by Tenet/NME. Had they used the word standard instead then they would have been required to specify what they were measuring and what the standards they were boasting about actually were. They could have been compared with others. One can easily be held accountable for not meeting defined standards. It is much more difficult to hold somebody accountable for "quality".

It is not surprising that the market has replaced the word standard with the word quality. It provides so much more opportunity for "legitimate business practices". It is like turning "need" into "demand" or "highly valued". Unless you examine the way words are used these subterfuges are not noticed and are accepted in support of invalid arguments.

CLICK HERE -- for more information about marketplace accountability.

CLICK HERE -- for another a page about quality which looks at the way it is understood by different people in different contexts.

CLICK HERE -- for another a page about quality and the health care professions

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This page created April 2000 by Michael Wynne