Interview with Cindy Barnard, MBA, MSJS, on quality in health care
Cindy Barnard, MBA, MSJS, is the vice president of quality for Northwestern Memorial Health Care in Chicago and oversees quality efforts at the systems of four hospitals, ranging from a 984-bed academic medical center to a 100-bed community hospital, and two large multispecialty medical practice groups.
University Center for Health Care Studies and serves as faculty for the Master’s degree program in health care quality and patient safety. Cindy engages with physicians, administration patients, and payers to understand their unique concerns regarding what constitutes quality care. I recently sat down with Barnard to get her perspective on what we really mean by health care quality.
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COLLINS: How would you define health care quality? BARNARD: There is a national consensus definition that comes from the Institute of Medicine’s 2001 report: “Crossing the Quality Chasm.” That definition includes the domains of safety, timeliness, efficiency, effectiveness, equity and what they call patient-centeredness. In the non-health care world, typically the word quality means “suitability of the product or service for the needs of the consumer or customer”; this is a detailed way of answering that question in health care.
certified professional in health care quality, she is also a research associate professor at the Northwestern
COLLINS: What do patients and caregivers associate with the term health care quality? BARNARD: When you look at the literature on patient centeredness in health care, the domains you will find are communication, compassion and hotel functions such as cleanliness, food and parking. However, that is certainly not a complete view of what patients and families think of quality. A big factor that influences perceived quality is in the communication component—both how health care providers speak to patients and how they did or did not give patients information, but also how they coordinated care and then spoke to patients about it. For example, if one doctor did an imaging study and then another health care provider didn’t even know that study had been performed, let alone what the findings were, then patients do not feel that their care was high quality and safe. I think handoffs, transitions and communication are going to emerge as major themes in what patients think of quality.
COLLINS: Payers, health care providers and hospitals often
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consider quality from unique perspectives. What common quality theme or themes do you think all of these stakeholders could agree on? BARNARD: There is some consensus on a set of measures distinguished for their feasibility; however, these are not necessarily optimal measures of quality. Most private payers look to National Quality Forum (NQF) endorsement as evidence that a measure is reasonable. Such measures may not be optimal—the feasibility of data collection has driven a lot of these consensus decisions. The majority of measures around hospital- acquired conditions, patient safety indicators and quality indicators are constructed on the basis of claims data.
There’s ample literature showing that when you do a really thorough quality study that these measures do not provide a comprehensive assessment of what really happened. They are being used as a proxy until such time as we have richer measures which will likely be derived from electronic medical records. Hospitals and health care systems have demonstrated that they can comply with
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