The paper in this week's Lancet [ https://www.hifa.org/dgroups-rss/quality-329-improving-health-and-social... ] notes:
'Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems.'
It's interesting to see quality of health services aligned with empowerment of families. Traditional views of quality have tended to focus on quality of care in facilities, but I believe there is a strong case for the quality community to embrace quality of care in the home as well. (HIFA originally raised this issue in response to the 2018 Lancet commission by Kruk et al, where we pointed out that the reported figures on deaths due to poor quality care actually included *only* those deaths that occurred at the facility level upwards, thereby excluding deaths due to poor quality care in the community. This point was only revealed through correspondence with the lead author. The paper had concluded that '5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care', but this in fact was a substantial underestimate. WHO now recognises that 'Between 5.7 and 8.4 million deaths are attributed to poor quality care each year in low- and middle-income countries', a figure which appears to recognise the contribution of poor quality care in the community.)
It is evident that families, community health workers, facility-level health workers, managers - all need to be empowered to increase quality of care and to reduce morbidity and mortality. This empowerment centres on the ability to access, interpret and apply reliable healthcare information.
I believe a change in perspective is needed. Thinking around quality of care should embrace community and home-based care as well as care at the facility, district and national levels. This implies a stronger focus on patient empowerment, as Richard Fitton said yesterday ('Giving patients their own health data and the tools to manage their health, immediate care, continuing care and preventative care seems to be an obvious action. It is a culture change of basic assumptions, values, norms and artefacts just as gender equality is.'). Conversely, it also requires a greater focus on empowerment of health workers, including those working in the community as well as those working in facilities. Health systems need to be explicitly both patient-centred and health-worker-centred. Indicators (including and especially the availability and use of reliable healthcare information) are needed of patient empowerment and health worker empowerment.
Best wishes, Neil
Let's build a future where every person has access to reliable healthcare information and is protected from misinformation - Join HIFA: www.hifa.org
HIFA profile: Neil Pakenham-Walsh is global coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information.
Twitter: @hifa_org neil@hifa.org
