Many of us in health care have at least two roles, one as a clinician and one as a consumer of health care. Most of us in leadership roles in health care delivery are familiar with the acronym STEEEP to describe the attributes that define health care quality, endorsed by the Institute of Medicine and the Institute for Healthcare Improvement.
As a consumer of health care, however, I would like to see three additional attributes. I would like health care to be cheaper while continuing to receive similar or greater quality health care. Cost-effectiveness is one of the components of the triple aim (improve healthcare quality, improve health of populations, and reduce per capita costs of health care). There is increasing awareness that a large part of the answer to reducing per capital costs of health care lies in addressing public health issues and social needs of individuals. There is also increasing emphasis on physicians to be cost-minded not only from a hospital perspective, but from the patient’s viewpoint on their out-of-pocket costs. Websites like healthcarebluebook.com help patients compare costs of the care they receive and leaders in quality can’t afford to ignore that. Sure, the ‘efficient’ component includes cost-efficiency but that’s mostly measured from the government perspective (e.g., Medicare spending per beneficiary) or from a hospital perspective. So, there – I’d like see ‘Cheap’ (for the patient) listed among the attributes, not as a stand-alone component, but standing right there with the other ‘qualities’ of health care Quality.
The other attribute that I’d like to see is that it’s ‘Accessible’. Having access is not the same as providing timely care. If you have ever been in the shoes of a physician discharging a patient home and would like to have him or her follow up with a primary care physician on certain labs or resolution of symptoms and your patient doesn’t have one, you know what I am talking about. Improvements in health care systems need to be intentional in expanding access to care. Many systems already do this intuitively as part of business and service expansion initiatives, but that’s largely confined to specialty care services because of potential financial gains.
The third attribute that I’d like to see in there is that health care that is ‘Relationship-based’. We can still have care that is patient-centered, but there are several studies showing improved patient satisfaction and outcomes when the clinicians have positive and effective relationships with each other and with their patients. Show me a patient who would not like to have more time with his or her doctor! Wearing my doctor hat, I have observed that patients who participate effectively in their care have better relationships with their doctors and nurses and I suspect they have better clinical outcomes. I share the growing sentiment among healthcare leaders that the pendulum may have swung too far from physician-centered to patient-centered health care, and the time for relationship-centered care may be soon upon us. I personally do not want to take the focus away from the patient, but maybe we could make the care more relationship-based so that we can provide more patient-centered care.
So, that leaves us with my new acronym to define health care quality – STEEP CARE, health care that is Safe, Timely, Effective, Efficient, Patient-centered, Cheap, Accessible, Relationship-based, and Equitable.