Quality healthcare could mean different things to different people but when you boil it down you essentially have to consider safety, efficacy, and efficiency.

Healthcare safety is not causing more harm to the patient with intervention.

Dr. David C. Classen, an associate professor of medicine at the University of Utah, uses a new method for identifying and reporting hospital errors. Using this new method, the researchers estimate that one in three people in the United States will encounter some kind of mistake during a hospital stay in the U.S.

This estimate is not to make people worry about seeking care in hospitals. Rather, hospital administrators and providers need to consider the factors that might contribute to poor patient safety (lack of resources, clinical protocols, etc.) Case complexity and/or acuity is one new trend contributing to medical errors. Because our ambulatory (outpatient) health care system is becoming increasingly advanced, the complexity and/or high acuity of cases that hospitals see is increasing. This increased level of care requires hospitals to be more prepared for emergencies and challenging circumstances. As complexity rises, so does the chance for error.

Healthcare efficacy is about whether the course of treatment achieved its intended effect.

Simply, is the course of medical treatment effective? Good healthcare providers have to manage a lot of variables–which is what makes medicine challenging–but If healthcare does not improve health, healing, or better manage end-of-life care (when inevitable) then what is the real purpose?

In an article in the New England Journal of Medicine entitled The Art of Doing Nothing , Dr. Rosenbaum writes: “we may choose to value an MRI more than the wisdom and experience of our physicians, but that does not mean that an MRI is inherently more beneficial to our health.” The long-run challenge for healthcare providers is to find and follow best practices, but be willing to accept new innovations as they’re properly vetted.

Healthcare efficiency is about getting good value for the money.

There are a plethora of ways to measure healthcare efficiency:

• Physician Labor
• Nursing Labor
• Administrative Labor
• Beds
• Depreciation of assets (a measure of capital)
• Medical Loss Ratio
• Episode/Clinical/Cost Groups
• Population-based
• Cost of Care
• Etc.

Each of these ratios has benefits and shortcomings, but whatever measurement method we use, we must consider the value we receive for the effort.

I’d like to make my last point by asking one question. Who is responsible for quality healthcare?