Health systems are complex. Very complex. The road to offering or getting the services needed may sometimes feel like a maze. In addition, there are multiple stakeholders involved in getting there and in assessing whether or not we got there the right way. Government and ministries of health, health professional colleges, staff, quality councils and accreditation bodies, management, patient advocacy and complaints commissioners are all important contributions to ensuring and improving the quality of care provided. But in such complex systems with such complex processes and numerous stakeholders involved, who’s responsibility is it, in the end, to ensure the quality of care? Well, it depends…
If we look at the quality of the professional acts, it is ultimately the professional bodies that are responsible. If we assess the quality of care received, it depends on who received it, which cuts across the patient experience and sometimes the local complaints commissioners. If we refer to overarching quality standards and programs to improve the quality of care on an ongoing basis, accreditation bodies such as Accreditation Canada are called upon to provide expertise, guidance and oversight. If, on the other hand, we wish to evaluate health outcomes and monitor population health indicators, then we end up relying on public health officials and government or organizational management to be able to capture the overall quality of health care and resulting outcomes. In a nutshell, there are so many different angles to the responsibilities associated with the quality of care that we end up back to square one in determining, ultimately, who is responsible for it. So, is there a way?
I believe the answer is also complex in its management but simple in principle: all stakeholders are jointly responsible. Coming together with different angles of evaluation, expertise and vested interests regarding the quality of care is the only way to capture the complexity of health care and improve the quality offered in a meaningful way. Of course, it is easier said than done. The first step is nevertheless to acknowledge that only by working together can we genuinely create a process whereby quality of care can be evaluated and improved. This is why a culture devoid of the ‘blame game’ is the one to nurture. Responsibility should not be associated with potential blame in a culture that truly fosters quality improvements. We must learn from our mistakes and be open and transparent about them.
Health care is complex and its quality is a direct consequence of how well we all work together to improve it. Of course, with such an approach, one might wonder whether any accountability can be associated with health systems at all. Getting from point A to point B in terms of assessing, monitoring and improving quality of care is challenging. One way to ensure a successful journey between A and B is to assign accountability to one or multiple stakeholders. However, assigning accountability does not change the need to work together, which is our shared responsibility. Assigning accountability may be useful but it always runs the risk of creating an easy way to solve perceived issues by attributing blame. This may sometimes help calm people down but it doesn’t solve anything. This is especially so when issues connect with the politics of health care. But this is a different story and a good one for another article…
In the meantime, may you be well, may you be happy.
B.