What is Quality?

February's Family Medicine had a great paper on the seventh element of quality: the doctor-patient relationship.

Key message:

The characteristics of quality are:

  • Effective Based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse)
  • Patient centered Respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions
  • Timely Avoiding unnecessary waits and sometimes harmful delays for both those who receive and those who give care
  • Efficient Avoiding waste, in particular waste of equipment, supplies, ideas, and energy
  • Equitable Without inappropriate variations that are attributable to personal characteristics such as gender, ethnicity, geographic location, or socioeconomic status
  • Safe Avoiding injuries to patients from the care that is intended to help them
  • Relationships  Sharing meaningful therapeutic interactions with patients and other members of the health care team


Spring, EHRs, Connections … Death

image from farm6.static.flickr.com Wilson the Wonder Dog died this weekend.  He was eleven (we think).  This is our last picture of him.  He was a happy, energetic doggy until the very last moment.   Last week – he had a wonderful walk/run at the golf course – where he and hunreds of his doggy friends enjoyed a sunny post-snowstorm afternoon.  The spark in his eye and (yes) his smile was infectious happiness.

Canine angiosarcoma – like the human one – is agressive and unforgiving.  In Wilson's case – it was hiding on his spleen until it ruptured suddenly on Saturday morning.  Two hours later – I was digging a very deep hole in the woods of our back yard.  

There is something fogiving about sudden death.  For Willie – it meant that he didn't suffer much at all.  But it didn't give his family any time to prepare for his absence.  Since I work from home most days – my world has become very different.  No barking (our other dog, Mookie has become very quiet) .. no tail-wagging .. no "hey dad can I go outside again" whines.  Just quiet.

So I look outside .. watching the latest snow deposit melt .. hoping for Spring and the lightness-of-being that seems to come as the windows open and new life emerges.

2011 has already seen many new things for our family .. not the least of which is that I resigned from my role as CMIO of one of the country's most successful EHR vendors.  This was a deliberate – and very carefully considered decision.  I did not ESCAPE from Allscripts.  Indeed – I learned an enormous amount there – and enjoyed my work very much.  So my move was more about going TO rather than going FROM. What I went TO was a small venture with a small, focused team – and big ambition to help patients and care providers collaborate.