Why a traditional health outcomes approach will fail in health care and a possible solution

Abstract

This paper challenges the assumption that improved knowledge of health outcomesand their causation will lead to more rational decision-making, resulting in improvedcare at lower costs. The assumption implies that the health system completely controlsall those functions, factors and initiatives that can affect the implementation of thestandard. These include policies, procedures, applications of techniques, skill mix ofstaff, inter-team interaction, communication systems, education, and so on. Changesin policy do not automatically mean a change in practice.Implementation is often approached in a manner that is perceived by staff as punitive,focusing on changing the individual rather than the system in which they work. Notonly is this approach opposite to basic total quality management principles, but it alsofails to acknowledge that most of the improvements arising from the health outcomesapproach are a result of staff being prepared to continuously work harder, often ignoringthe ?system?, to maintain their high standard. However, continuing deterioration in thesystem in which they work sets the scene for an accident or incident to occur.The answer lies in revisiting the traditional quality assurance cycle and acknowledgingthat health care has never been able to effectively ?close the feedback loop?, that is, thehealth system is continuously increasing the sophistication of data collection techniqueswithout giving equal consideration to what needs to be done to ensure effectiveimplementation and evaluation.This paper outlines how Campbelltown Health Service directly addressed this issuethrough its process of achieving international certification to ISO 9002:1994.