Question

How might different individuals within a health care organization view health care quality? Please provide specific examples of their perspectives and how they impact the delivery of quality care.

Answer 1

A study was conducted to understand staff perspectives of quality in health care practice.

Using grounded theory and qualitative, in-depth interviews this research studied how primary care staff understood and assessed their own performance and quality in everyday practice. 21 people were interviewed, comprising of health visitors, occupational therapists, managers, human resources staff and administrators. Analytic themes were developed using open and axial coding.

Example: When asking staff how they understood performance they spoke of the tacit and experiential aspects of the clinical decision making and quality of care.

Individual staff may have different standards, partially based on clinical training and professional roles, but also extending to personally based standards. This element of personal standards was apparent across all job roles, whether clinical, managerial or administrative: ‘I think quality indicators are quite an individual thing actually for clinicians, I think different people depending on where they’ve come from and probably different professions, would have a different notion of what a quality indicator would be.’ (Interviewee 18, clinical manager).

Clinicians spoke of the dilemmas they faced in working with large numbers of patients, whilst ensuring sufficient time was spent with each to provide the most effective service. Where there were financial constraints this could strain staff’s capacities to deliver the levels of quality of care that they valued as part of their professional expertise.

Staff exhibited a great degree of intrinsic motivation, people’s sense of job satisfaction was highly connected to their motivations for going into their professions.

It was illustrated how quality measures and professional standards may not always align with individualised, patient-centred approaches that are led by patients’ values and concerns. This was brought to life in an example where aspects of person-centred care clashed with particular professional practices. Here, when nursing a sick child with a terminal illness, they spoke of how their care was sensitively discussed with the family. Here aspects of quality were co-created in discussions between professionals and the patient and family. The wishes of this patient and family were not always aligned with particular nursing practices, for example not always wanting to be tidy with brushed hair. When a different clinician intervened she differed with the patient-centred approach negotiated with the family, following her own, different professional standards. Here both standards may be appropriate at different times. This example illustrates in practice how quality can be co-produced through dialogue at the service interface, and that quality extends from the interaction and conversations between practitioners and those who are using a service. Overall the findings illustrate the importance of staff values, attitudes and standards in co-producing quality in everyday service interactions, alongside ongoing communications with the users of a service.

Reference:

• Michelle Farr and Peter Cressey. Understanding staff perspectives of quality in practice in healthcare. BMC Health Services Research. 2015.15:123. Available from- https://doi.org/10.1186/s12913-015-0788-1