What is quality health care? Quality is a multifaceted concept which can be defined in defferent ways. At a broader level, quality reflects the extent to ahich a healthcare service or product produces a desired outcome.
The agency for healthcare reasearch and quality (AHRQ) defines quality health care ‘’as doing the right thing, for the right patient, at the right time, in the right way to achieve the best possible results. But simply put, health care quality, is getting the right care to the right patient at the right time – everytime.
There are three basic dimensions to this: structure, process and outcome.
Structure represents the basic characteristics of physicians, hospitals, other professionals and other facilities, if the structure is solid, we can concern ourselves with the process which is basically having the right things done the right way. The 3rd diamension, outcome, reflects the end result of care, did people get better?. Toghether, these three components are the foundation of providing quality in health care.
On 26th of January 2016, a story broke out in the news in UK of a year old baby boy that was found dead in his cot by his mother from sepsis after series of mistakes by GPs and the NHS
(sky news report). Sixteen mistakes were pointed out and it includes:
• GPs who saw him six times in the months leading to his death failed to look for signs of sepsis
• His GP had not recorded all the necessary information in his notes
• Doctors working out of hours were not able to have access to patient medical records
• The system used by hotline that includes a box ticking questioneer by staffs is not ‘’sensitive’’ enough to identify when children are deteriorating because of s deadly inflamatory condition.
This tragic occurance has showed failures in the diamessions of quality health care structure and processes leading to the undesirable outcome of death of this child. Lessons has been learned about the need for to constantly review and update healthcare policies, systems, and processes for continued improvement in quality.How often do Nigerians eceive quality care?
Research and reports indicates that health care quality in Nigeria is almost non existent or at its best only practiced by a handful of healthcare institutions and this has resulted in inequality in quality. This studies in quality in health care has 2 common findings, irrespective of focus or locations:
1. A substantial gap between the best possible and actual care
2. An even larger gap for the poor, those with limited education and those in remote areas (rural areas).
What is being done to improve health care quality in Nigeria?
The challenge may have borne out of the fact that there is no recognised body in Nigeria that regualtes or assess the quality of health care services being delivered in the country. A few institutions that has any form of certifications, were obtained from international cerification and regulatory bodie like the Joint Commission International (USA) and Council for Health service Accreditation of south Africa (CHOSASA) which is the only internationally accredited quality improvement and accreditation body for health care facilities based in Africa.
The evidence that Nigerians health care needs improvement seem to have many leaders in the healthcare sector thinking that it ia time to act. Recently, the Society for Quality in Healthcare in Nigeria (SQHN) is seeking accereditation from the International Society for Quality in Health care (ISQua) – ISQua is the global body that regulates the performances of health care facility accreditors – once accreditted, they will be able to certify healthcare centres, and hospitals for various levels of quality care.What Next?
Consumer and health Literacy: health care is often a confusing word of technical language not easily understood by most people. Poor understanding between health care providers and their patients leads to poor quality care. A patient who cannot follow her doctor’s advice is unlikely to get needed care.
Arming consumers with solid information about healthcare quality is one of the most effective ways to improve quality. There is a need to help consumers learn more about their care.NHIS and HMOs:
The current way for reimbursing health care providers by the National Health Insurance scheme (NHIS) and Health Maintenance Organizations (HMOs), is either by capitation or fee- for – service. Thus most payments for health care relates to how many services (known as volume for care) are delivered; we also tend to pay more for care to treat an illness than we do to prevent it and as a result, there is little financial incentive to improve quality by providing only the right care.
While there is no ‘’perfect’’ payment system, paying doctors for providing quality care encourages then to provide care that follows evidence. Today, most doctors and hospitals are paid more money if they provide more services to patients; but more care is not necessary better care.
Training: A lot more has to be done to involve healthcare professional in the quality drive and it involves creating the awareness about quality in healthcare and training