Quality Care Requires Freedom

In 1976, researchers manipulated a cohort of nursing home patients.  They split them into two groups.

The first group got choice, control and responsibility. They learned to take responsibility and make choices. Then, researchers gave them a plant to care for and nurture as they thought best.

The second group learned that staff would take care of everything; they were in good hands. They also got a plant, but staff cared for it.

Researchers found that the responsibility-induced group were more active, happy, alert and socially involved at the end of the study.

Even nursing home patients do better with autonomy, responsibility and choice.

Quality Care

Noise about quality care echoes into every nook of healthcare today. Most agree it includes: safe, effective, reliable, patient-centred, timely, efficient, equitable care:

• Canadian Institute for Health Information
• Health Quality Ontario
• Institute for Healthcare Improvement
• World Health Organization
• Institute of Medicine: Crossing the Quality Chasm 2001
• The British National Health Service defines quality care as clinically effective, safe and offers a positive experience for patients. It leaves out efficiency and equity.

Yes to Quality, but how?

No one campaigns for low-quality care. Everyone loves quality despite worries that some see it only as a way to cut costs.

Planners and progressives believe quality comes when strong leadership controls a system. Most ‘experts’ focus on data, decreasing variation and increasing adherence to guidelines. They allude to engaging physicians but generally assume physicians are just a tiny part of the flawed system (Brookings centre, 2012 Ontario’s action plan, How to improve – IHI).

A great system should guarantee that physicians behave and patients do what they were told.

Quality & Productivity

Improving quality in healthcare requires people to behave differently. Policy can help.  But people determine quality. Quality needs more than rules and protocol.

In a way, quality care presents the same challenge as productivity in industry. Workers ultimately determine productivity. Figure out how to inspire workers and you’ve figured out how to drive productivity.   Great systems alone do not guarantee great businesses.

Productivity & Autonomy

Freedom for workers means productivity for companies (Forbes).

Workers in routine jobs do not increase productivity with more autonomy, but satisfaction increases.  However, in evolving work environments, autonomy is “more important than ever” at improving productivity (BusinessNewsDaily).

Quality Care Requires Freedom

The business world knows that passionate, free, innovative workers produce higher quality work with less effort. See “Increase productivity through passion and freedom“.

Highly trained professionals fill Canadian healthcare at all levels.  Patients need the best from their caregivers.  Systems should provide structure that promotes freedom, creativity, innovation and critical thinking. Command and control will not deliver the highest quality care. It might achieve cost cutting through limited variation. It will never inspire providers to drive quality beyond basic standards.

Inspired individuals driven to achieve outstanding results deliver quality care. Regulation and control cannot produce quality in an evolving environment. We need providers who are passionate, autonomous and willing to shoulder responsibility.

What do you think?

Should government spend most of its time stamping out low-quality performers, reducing variation and increasing monitoring? Or should it spend most of its time unleashing the creative intelligence of professional providers to improve the system for patients? Can it do both at the same time?

photo credit: ikea.com