The Greatest Obstacles to Improved Quality of Care

The paramount metric by which all medical professionals and organizations should be measured is quality of care.  Although the Holy Grail of 100% health in 100% of patients may be unattainable, every healthcare entity should strive tirelessly for it because it motivates employees and fosters an atmosphere of constant improvement. The quality of U.S. healthcare should be examined more closely in light of a recent study by the Commonwealth Fund, which found that the U.S. ranks last among 11 Western nations in terms of quality of healthcare.

 Within this umbrella standard are a multitude of sub-metrics which contribute to the overall success of an organization including:

• Optimal utilization of preventive care
• Elimination of unnecessary and counter-productive diagnostics and treatments
• Effective cooperation among departments and team members
• Integration of maturing technologies and treatments

Almost all successful Accountable Care Organizations make an effort to improve their quality of care in order to appeal to more healthcare employees and patients, as well as earn approval from various governmental organizations. In recent years, quality of care has also been emphasized as the Affordable Care Act has introduced various incentives and disincentives to undergird an overall improvement in the healthcare industry. 

Poor Management Hinders Healthcare

Despite almost $3.09 trillion in healthcare expenditures in 2014, the quality of American healthcare trails behind those of other developed nations.  Among the most important barriers to enhanced quality of care is the inability of many ACO's to utilize resources effectively.  This obstacle is most visible in many healthcare groups' lack of integration of medical data.  In a survey of 62 ACO's by Premier healthcare, almost 90% reported that data integration was seriously impeded.  These administrative difficulties not only make it more difficult for inter-organizational communication, but the difficulties in administrative duties also sap clinical time and the desire to out-perform in physicians.

Another key obstacle to more successful healthcare delivery is the lack of reliable metrics.  Although the broad outlines of care quality can be conceptually identified, most healthcare organizations fail to translate them into portable metrics.  A study in the International Journal for Quality in Health Care found that most hospitals use quality indicators, but due to significant variation in their methods, it is difficult to determine how well any organization is performing or improving.

Treatment Related Issues

The interaction scenario between physicians and patients has evolved rapidly in recent years.  The average amount of time that physicians devote to an individual has shrunk from 20.8 minutes on average in 2010 to almost 11 minutes or less in most primary care visits at ACO's. This diminished dialogue has prevented truly effective communication between patient and caregiver which could better identify health issues.  This shrinking window of communication is of course driven by financial restrictions in which primary care physicians must complete more visits to generate profit for the employing organization.

This emphasis on quantity instead of quality has a damning effect on the healthcare system.  Not only is there increased depersonalization of patients which chills the all-important patient relationships, but it also inhibits the will to perform by physicians who often entered the profession to interact and care for patients.  Primary care physicians who are trapped in ACO's which prioritize "assembly line" care often experience heightened levels of dissatisfaction and are more prone to making medical errors. 

There is a broad array of issues that prevent implementation of optimal healthcare throughout the country.  While some of these are beyond the ability of medical professionals and organizations to solve, many others are firmly within their grasp.  With just a few, relatively easy strategies they could dramatically improve the quality of care they provide and improve the health of their patients. 

Article written by:

Robert Moghim, M.D.

CEO, Health Carousel Locum Tenens