The market, patient loyalty, patient safety, CABG deaths, patient surveillance, cost saving

Citation

Hurst, K. (2011), "The market, patient loyalty, patient safety, CABG deaths, patient surveillance, cost saving", International Journal of Health Care Quality Assurance, Vol. 24 No. 4. https://doi.org/10.1108/ijhcqa.2011.06224daa.001

The market, patient loyalty, patient safety, CABG deaths, patient surveillance, cost saving

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 24, Issue 4

Connections between marketing and service quality generally and health service quality specifically were well made in previous IJHCQA articles. But it seems we have more to learn. Even in not-for-profit health services, especially those in countries like England with “Choose and book” policies (general practitioners (family doctors) ask patients which hospital they want to go), patient loyalty is important. So, how can we measure and improve patient devotion? Patient satisfaction and hospital stay, according to Daniel Kessler and Deirdre Mylod, are promising regression variables. The authors remind us that satisfaction is sensitive to many structures, processes and outcomes such as treatment compliance and legal redress, which logically are related to loyalty. The authors worked hard to broaden their sample (previous studies were on the small side). Their findings are interesting and important, and as usual, outcomes range from expected to surprising. It seems there are subtleties with which we need to wrestle. For example, if reasons for returning to hospital is different from choosing one then are both loyalty measures? Nevertheless, high-loyalty hospitals have important characteristics that we can emulate.

Patient safety also remains a popular author and reader topic; indeed, we published a patient safety special issue (IJHCQA, Vol 20 No 7). Momentum continues; and in this issue we publish a follow-up article by Ari Mwachofi, Stephen Walston and Badran A. Al-Omar who focus on the largest healthcare professional group – nurses – and their patient-safety perceptions. Treating nurses as patient safety barometers makes sense since they provide a 24 hour, seven day service and observe most patient activity. The study and article is Saudi Arabian centred and includes safety perception data from Saudi Arabian and overseas educated nurses. The authors, intriguingly, asked 850 nurses (67 per cent responded) not only for their broader patient safety views (whistle-blowing, etc.) but also how safe they would feel as patients in their hospitals – a professional enquiry equivalent to the ultimate question – how likely are you to recommend this health service to family and friends? (Reichheld, 2006), often put to patients. Using logistic regression, the authors connect patient safety variables, which feel intuitively right. Perhaps the most important outcome was that feeling safe if treated in the hospital in which you work question might become a safety and quality barometer question for recruiting and marketing purposes.

Given that dental care is an everyday, high-demand service, dental care quality assurance is not a regular feature in IJHCQA (although there are ample dental specific journals that feature dental service quality). Dental care demand is growing in India (a country with a high dental caries incidence) and experts feel that service expansion and related quality is not being monitored. In this issue, therefore, we publish Prasad and Varatharajan’s large-scale and triangulated dental service quality evaluation for which the authors use data envelopment analysis (DEA). They raise interesting paradoxes. Despite more dental practitioners competing for patients, service quality does not seem to be improving, but prices are increasing (although better quality services are more expensive), which implies that market forces do not operate and that price, quality, flexibility and delivery are largely unaffected by the market. The authors found that clinic size, location and facilities were stronger service quality drivers. They note that practices with certain characteristics have a competitive advantage. Clearly, dental service QA is not straight-forward.

Peri-operative deaths are an important outcome measure and, therefore, a crucial quality indicator. In this issue we publish an extensive CABG study by Cristina Rodríguez-Rieiro, Paz Rodríguez Pérez, Susana Granado de la Orden, Mercedes Moreno Moreno, Ana Chacón García and Amaya Sánchez-Gómez who interrogate existing databases to compare global CABG death rates with Spanish regional ones. The Spanish rate was slightly lower than the global figure but more significantly, regions varied. Differences between hospitals are generally well known but care is needed about controlling variables that could unfairly represent a hospital. The authors, therefore, using aggregated data from 37,861 patients at regional level, group data so that results are fairly represented using regression analysis and ROC techniques. They generate significant insights into patient undergoing CABG, who subsequently die. Clearly, these characteristics should act as flags to alert practitioners about patients at risk. Perhaps the most important outcome, and one noted repeatedly in other studies, is that surgery frequency is strongly associated with deaths in hospital. In short, more procedures mean more competent staff.

Asthma is an important disease in most countries, an illness that has quality of life and significant socio-economic implications. Consequently, Isabella Karakis, Moshe Blumenfeld, Yaron Yegev, Dan Goldfarb, Arkady Bolotin, Zeev Weiler and Rafael Carel in this issue look at asthma patients and treatment compliance in one large Israeli Health Maintenance Organisation. Their main aim, however, was to test how feasible it is to aggregate data from independent electronic databases for asthma surveillance purposes. The researchers linked three important databases, which generate important insights not only about asthma service quality but also data accuracy common to the same patients. If QA managers can access patient databases then they can use data mining techniques to flag patients off the radar and to improve: service quality; quality of life; and financial savings, a win-win situation. Bonuses include better audit research and development arising from large-scale database development and analysis.

United States healthcare costs escalating, but it is not until we get chapter and verse from Charu Chandra, Sameer Kumar and Neha S. Ghildayal that we see how frightening and worrying cost escalation is for insured and non-insured US citizens. The authors rightly point out that costs are out-of-control. Cost and quality are strongly connected – better service quality saves money since, for example, hospital stays are shortened. Cost savings, on the other hand, can be injected into front-line services to improve service quality – a variation on the quality spiral. So, what savings are possible? The authors examine two major cost items in detail (medical billing and procurement). Inexplicably, US costs are considerably higher than Canada’s, which in itself is worth studying. Using Monte-Carlo analyses, the authors show how and where savings can be made, which they estimate to be $billions per year. The article has a bonus; the authors show how missing data stymies these analyses, but that creative analysts overcome missing data problems by locating alternative data sources.

Keith Hurst