With thanks to Shams Syed, WHO. Citation, extracts and a comment from me below.
CITATION: Editorial| volume 10, issue 8, e1073, august 01, 2022
Forging new paths in measuring quality to improve cancer care
The Lancet Global Health
Open AccessPublished:August, 2022 DOI:https://doi.org/10.1016/S2214-109X(22)00291-1
On June 4, WHO and the American Society of Clinical Oncology (ASCO) formally announced a collaboration “to measure and improve the quality of cancer care internationally”. This is urgently needed given the rising global burden with ever-widening disparities in outcomes between and within countries.
One striking example in this month's issue is the prospective study by the Global Retinoblastoma Study Group, which found a 3-year mortality of 57·3% for children with retinoblastoma in low-income countries compared with 99·5% for those in high-income countries...
Back in 2018, The Lancet Global Health published a Commission on high-quality health systems. The driver behind the Commission was the staggering realisation that more people die despite accessing health care for a treatable condition than who die from not accessing care...
Health systems in highly industrialised settings are still on the difficult path towards consistently delivering high-quality care equitably and sustainably... The use of relevant, feasible and responsive indicators of health system performance is essential. However, when these are converted into performance targets with high-stakes ramifications for providers if those targets are not met, it shifts the drivers of practitioner and organisational behaviour away from the intended goal, and towards measurement and the meeting of performance targets. This excessively narrows the scope of quality improvement initiatives, often paired with burdensome data collection, limiting their scalability and impact. Worse still, such targets can create perverse incentives and unintended consequences, hindering quality or leading to avoidable harm. Two strategies can be adopted to mitigate against these pitfalls. First, ensuring quality indicators represent what is important to service users... Second, improving quality through a broader lens than addressing processes and behaviours at the health-care facility level...
COMMENT (NPW): Given our in-depth HIFA discussions on Quality in recent months, supported by the WHO Global Learning Laboratory on Quality Universal Health Coverage, I find it shocking that quality improvement in high-income countries is often a tick-box exercise with 'unintended consequences, hindering quality or leading to avoidable harm'. It's really important this gross failure is not replicated in LMICs. The second point the authors make about 'improving quality through a broader lens than addressing processes and behaviours at the health-care facility level' echoes the thrust of our whole HIFA discussion about aquality, where we saw it collectively on multiple levels: national, district, facility and community. Again, a narrow view of quality at facility level may be the appropriate focus for some professionals at an individual facility, but it must be positioned also as part of a wider, dynamic system.
HIFA looks forward to see the outputs of the WHO-ASCO collaboration “to measure and improve the quality of cancer care internationally”, and meanwhile we stand by to provide a platform for multistakeholder exploration of the issues if the collaboration elects to consult widely across the global health community.
Best wishes, Neil