The “Central de Resultados” (Results Central) mission is to measure, evaluate and distribute the results achieved by different public health care system centres. The aim is to facilitate better decision-making with regards to the quality of the health care service provided to citizens. The reports feature results from patient satisfaction to the efficiency in the use of resources. The ultimate goal is to foster an internal review of the elements that influence the results, especially in organizations that repeatedly show indicators which are worse than others. To encourage this task, the institutions are nominally identified: not as a punishment but as an incentive to improvement.
Last November the “Agència de Qualitat i Avaluació Sanitària de Catalunya” (AQuAS) released the results for 2013 for hospital and primary care, social care mental health and addiction treatment. The “Central de Resultados” report for hospital care consists of 99 indicators and presents some new features over previous editions. One of the most important is the inclusion of a synthetic indicator of adequacy, in which avoidable hospitalizations for heart failure, diabetes or chronic obstructive pulmonary disease weigh heavily, but where other indicators are also given their due significance. Given its complexity, this new indicator of adequacy was the subject of a detailed explanation during the public presentation of the results and, at the same time, is one of the most featured in the media. In this case, among other centres, the Hospital de la Santa Creu and Sant Pau are examples of the hospitals which should improve this indicator, and thus the media picked on the aforementioned report.
Summarizing the quality of health care provided by a hospital based on a single indicator is very difficult. Now, since the media highlighted the results of this particular indicator, the responsibility for it shall not rest with the messenger but with the issuer, in this case, me. Surely, the communication was poor because if we continue to analyze the report to its full extent we can observe other relevant indicators. For example, the indicator of mortality at 30 days after discharge for selected causes – another novelty of the presented report – shows how a hospital that let’s say has poor results in the synthetic indicator of adequacy, can at the same time have excellent results in the indicator of mortality, such is the case of the Hospital de la Santa Creu and Sant Pau. This is an indicator that is made public in very few public health systems, and some agencies, among which American and British, have promoted its use. Similarly, in other indicators, such as satisfaction with the emergency services, the same Hospital de la Santa Creu and Sant Pau obtained the top positions, as has been well reflected in the media.
We have to keep in mind that the same indicators, despite many efforts, do present some shortcomings, starting with the absence of important outcomes such as the functional ability of patients and their quality of life related to health. But there’s something else that also escapes and that only very specific studies can analyze. I’m talking about the culture of the organization that is largely configured for all the staff that belongs to it; what values they share and the feelings they have towards it. Those organizations that – despite facing serious external problems and discouraging states of mind, present in any collective, – believe in the values that inspire their work; have as their objectives continuous quality improvement; where everyone is involved regardless of age or position (from the manager to the warden), have a better communication and coordination between professional and technical groups; know without shame or guilt how to examine the causes of their mistakes or failures; participate and get involved in improvement proposals; all these difficult to collect and analyze features at the organizational and staff level are at the moment of truth, the ones making a difference.
The Results Central is not a perfect instrument, but provides data for evaluating public policies, helping to insure that the established objectives are met and that an efficient allocation of public resources is made. Furthermore, transparency in policy making and accountability in the management of public resources is a requirement of citizenship, a democratic and ethical obligation of governments, and a key element in the development of a country.
The Department of Health, through AQuAS, does not avoid discussing sensitive issues, such as the reports from the Central de Resultados presented last November or the report on the effects of the economic crisis on the population’s health. The press has always addressed these issues with appropriate importance, seriousness and rigor. Therefore, it’s a shame that due to an issuer’s (not a messenger’s) miscommunication they can misinterpret the results and end up detracting from the outstanding work performed by professionals in extremely difficult conditions, so that the thousands of citizens served, cared for and cured on a daily basis know they are in the best possible hands.