Developed and developing country QA issues

Citation

Hurst, K. (2012), "Developed and developing country QA issues", International Journal of Health Care Quality Assurance, Vol. 25 No. 3. https://doi.org/10.1108/ijhcqa.2012.06225caa.001

Developed and developing country QA issues

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 25, Issue 3

Instigating screening and prevention programmes for pregnant women can reduce maternal mortality. Despite Iran’s developing health services, it has a stubbornly high maternal and infant mortality rates. Using the quality cycle and Donabedian’s structure, process and outcome QA framework, therefore, Masoumeh Simbar and colleagues set service standards before comparing services against standards using comprehensive triangulation despite missing statistics such as death certificates. The authors’ sample size is impressive and their findings, which they feel are Iran’s first, show some fundamental service-shortcomings notably educating mothers and appropriate prevention programmes. However, knowing your service limitations is an important quality-cycle step and the authors are much closer to improving maternity services.

Despite its relative simplicity, poor communication remains the commonest patient-complaint. We do not seem to be very good at informing patients about diagnoses, treatment and care. However, judging by Jakobsson and Holmberg’s study into professional to cancer-patient communication, including message content, method and timing, things are not that simple; for example, patient satisfaction with professional communication varies according to the staff group. Also, there are patient types, which mean that some do not assimilate complex information easily. Moreover, it seems important that information strategies do not just focus on the in-patient phase; rather we should be thinking long-term (12 months post-discharge) and be developing evidence-based communication strategies. Consequently, the authors recommend the concordance model, where patients are actively rather than passively involved in professional-patient communication. As a bonus, the authors highlight important methodological issues regarding surveying cancer patients – notably drop-out owing to obvious things like death and less obvious constraints such as patients lacking energy to complete long questionnaires. Clearly, there are policy and practice lessons for all.

Morbidity and mortality conferences (M&MCs), important for patient safety and service improvement, although labelled differently in other countries, have been around for 100 years. Because they take apart circumstances surrounding untoward clinical incidences, they are valuable educationally. So can we capitalise on their impact on service quality? Elodie Sellier and colleagues evaluate French hospital M&MC structures, processes, outputs and outcomes. They found that M&MCs varied and dynamics changed according to specialty and audience. Conference reporting was mixed partly depending on whether the meetings were multidisciplinary. The authors also found M&MCs face several threats such as time constraints. Several useful recommendations emerge from this unusual and valuable work. Should M&MCs be mandatory and given protected time? And should the best M&MC structures and processes become standards by which all conferences should be run?

Fortunately, flu (and other infection) pandemics are rare. However, our inexperience means that we have little quantitative data for strategic and operational planning when pandemics threaten. So, what if avian flu had really caught hold? What would happen to business and public services – do we know a pandemic’s likely full extent? Can we generate guidance to help managers and planners prepare for pandemics? Can healthcare staff learn anything from private businesses and vice-versa? In this issue, Sameer Kumar uses sophisticated software to analyse a pandemic’s likely impact on businesses, which can be extrapolated to healthcare. Sound practical and policy recommendations emerge, which are represented graphically and qualitatively.

How do we fund healthcare that is fair for all – ensuring fair access and equality for the most vulnerable? For those countries without national health services, free at the access point, how efficient and effective are health insurance schemes? David Forbes takes a long, hard look at India’s healthcare provision (likely to become the most heavily populated country, where 70 per cent live in rural communities, some distance from mainstream health services). His starting point is that health-insurance based schemes (more likely in India owing to the low GDP proportion the government devotes to healthcare) need to be evaluated before they are implemented – replacing struggling local health services with westernised health insurance schemes, untried in developing countries, might pour petrol on smouldering embers. India’s large rural population is the most disadvantaged and the most vulnerable. Their morbidity and mortality data are not good and the problem is compounded when hospital expenses deplete users’ meagre household incomes. Moreover, paying for something (e.g. health insurance) that may never happen does not sit well with India’s poor; and risk pooling is not something they understand. Health insurance companies are profit not philanthropy driven so the author looks at three models for improving health services to India’s most vulnerable people. Each model has strengths and weaknesses, but it seems that well-managed charitable hospitals are a good option if they can avoid deficits and provide acceptable healthcare services.

Significant effort goes into creating and disseminating (in this case infectious disease) evidence-based clinical guidelines. Indeed, we are at the stage where published research meta-analyses can extract the best from the rest. But what happens if clinicians want to follow different guidelines judged more appropriate for local use. Can these diversions be justified? These are important points not least because Husayn Al Mahdy reminds us that economic issues are not that well analysed in the clinical guideline literature. There are patient safety issues too since guidelines are crucial to junior clinicians working out-of-hours often without senior clinician support. The author notes that there is not always agreement in the literature about what is most efficient and effective practice, so we may need to accept varying practices that work.

Keith Hurst