Getting more health from healthcare: quality improvement must acknowledge patient coproduction—an essay by Paul BataldenBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3617 (Published 06 September 2018) Cite this as: BMJ 2018;362:k3617
All rapid responses
Re: Getting more health from healthcare: quality improvement must acknowledge patient coproduction—an essay by Paul Batalden
Dr. Paul Batalden’s contribution to quality improvement cannot be overstated. His thought piece published in BMJ highlights the limitations of thinking of healthcare as a product or as a service industry, and promotes the value of shared decision-making. I would like to suggest a slightly different perspective.
The work of Elijah Goldratt in promoting the theory of constraints starts with the imperative of understanding what it is that our industry produces. Does the healthcare industry produce optimal healthcare outcomes, as Dr. Batalden suggests in his feature? I would like to propose that our healthcare industry is actually driven to produce healthcare decisions. The process of seeing a primary care physician and having tests in order to diagnose or manage an acute or chronic condition is to optimize the resources he has at his disposal to make those healthcare decisions.
To optimize healthcare decisions, acute, care, primary care, specialty care, nursing home and rehabilitation care should all be redesigned to optimize healthcare decisions. Although it might seem as if this process does not apply to surgery and that a surgeon produces a surgical outcome, she really does not produce a surgical outcome. She makes a decision to perform a surgery in the right person, at the right time, with the right equipment, and the quality of that decision drives the value of the healthcare received. How can healthcare decisions be optimized? The process of producing the best healthcare decisions requires not only the right tests and specialists, but the patient and multidisciplinary team insight into the status of the current condition, the target healthcare goal, and the acceptable risk in reaching that goal. The interprofessional team and patient must train themselves to work together, communicate, trust each other. Thus, healthcare decisions are the true output of the healthcare industry, and decisions can only be optimized by shared decision-making. We can measure the quality of our care by measuring the process of the decisions, and the degree in which the decisions adhere to the goals of the patient.
I would like to thank the faculty of the VA Quality Scholars program, as well as my mentors Matt Barnum, MBA, and Jason Gatliff, PhD. They are not to blame for any misconstruing of their ideas in this perspective.
Competing interests: No competing interests