There are many trends in health care these days, two of
which focus on quality and compassion within the system. One can even speak of
a Quality Revolution, given the
strong emphasis this concept is currently receiving. Quality focuses on issues
such as efficiency, safety, evidence-based medicine, decreasing treatment
variability, and cost-containment. Quality is a growing focus in both the UK
and the US:
“Health Care Quality
Improvement is a broad range of activities of varying degrees of complexity and
methodological and statistical rigor through which health care providers
develop, implement and assess small-scale interventions and identify those that
work well and implement them more broadly in order to improve clinical
practice,” (Mary Ann Bailey, (UK), The Hastings Centre).
Reports on quality issued by the Institute of Medicine:
Crossing the Quality Chasm: A
New Health System for the 21st Century (2001): http://www.iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx
To Err is Human: Building a
Safer Health System
(1999): http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx
Influential organizations concerned with quality include:
Ko Awatea
(in New Zealand): http://koawatea.co.nz/
Institute
for Healthcare Improvement: http://www.ihi.org/Pages/default.aspx
The
Hastings Center: http://www.thehastingscenter.org/
Robin
Youngson (New Zealand) who has written a book called Time to Care, http://www.time-to-care.com/
and created the organization, Hearts In Healthcare, http://www.heartsinhealthcare.com/welcome
Parker
Palmer (US) whose book, The Courage to
Teach: Exploring the Inner Landscape of
a Teacher’s Life, has led to the creation of The Center for Courage and
Renewal http://www.couragerenewal.org/ which is running its 2nd Annual Health Care Institute, Integrity in Health Care: The Courage to
Lead in a Changing Landscape in 2013.
ALIA
Institute (Authentic Leadership In Action) (Canada): http://aliainstitute.org/ is an
organization that promotes mindfulness-based leadership, and it grows out of
the Shambhala organization. In 2011 they ran a program called, Leaders In
Health.
Physician
Heal Thyself: http://www.physicianretreats.com/
Heal
Thy Practice: http://holisticprimarycare.net/heal-thy-practice-conference
It could seem that these are two different revolutions going
on at the same time and that only one can “win.” We could emphasize quality instead
of compassion, but we then end up with a doctor-patient relationship that is formulaic,
technical, and more focused on cost-saving than care-giving (some may say we
are already at this point). Doctors would become interchangeable technicians
and patients would become passive recipients of care (“docile bodies” to quote
Foucault). We could emphasize compassion over quality, but this doesn’t seem to
be a desirable outcome either, to have health care professionals who are kind
and nurturing, but incompetent and unsafe.
Do we have to choose between having quality or compassion in
health care?
We could identify compassion as a variable of quality in health
care, but how can we make sure that compassion would remain more than just a
window-dressing variable? For instance with the biopsychosocial model of health,
the psychosocial aspects are often considered not as important as the
biological dimension in teaching and practice.
So often in medicine, money and numbers trump more humanistic values. How
do we create a model of health and illness and a health care delivery system that
values both quality and compassion?
In terms of the identity of the physician, this tension
manifests itself in the forces arguing that physicians should be technicians limited to evidence-based
and protocol-based interactions or healers
who spend time with patients at a human level and creatively pursue various
treatments. The concept of there being two important aspects of medicine, the art of medicine and the science of medicine, seemed to
co-exist peacefully for some time, although now there seems to be a rift
between evidence-based quality and compassion-based focus on human relationship
and multi-modal approaches. Science and economics threaten to push the art of
medicine and humanitarianism into the background.
Is there some way to unite these two seemingly different
revolutions? Could we have health care
that is compassionate, safe and efficacious?
How could this be done? These are
the kind of questions that this blog, Creating
Human Work Environments, would like to explore.
