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Evaluating the Quality of Health Care

3. Defining Quality of Care

These aims describe two related, but distinct types of excellence; technical and interpersonal (Donabedian, 1965, 1988).  Interpersonal excellence refers to care that meets the information, emotional, and physical needs of patients in a way that is consistent with their preferences and expectations.  Another term for this type of care is "patient-centered care" (Cleary, P. D., Edgman-Levitan, et al., 1991).  One important aspect of interpersonal care is patient involvement in decision making  (Barry, Fowler, Mulley, Henderson, & Wennberg, 1995; Braddock, Edwards, Hasenberg, & et, 1999; President’s Commission for the Study of Ethical Problems in Medicine and Biomedical  and Behavioral Research, 1982; Sepucha & Mulley Jr, 2009; Salzburg Global Seminar, 2011). 

It is important to distinguish between excellence of interpersonal care and patient satisfaction.  Patient satisfaction is commonly measured and many consider it an indicator of medical care quality.  However, patients may be satisfied with poor quality care (Cleary, P. D. & McNeil, 1988).

Thus, it is important to specify interpersonal aspects of high quality care and ask patients to report about those experiences. It may also be useful to rate the extent to which care met patient expectations, but it is important to recognize that high satisfaction does not necessarily imply high quality.

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President’s Commission for the Study of Ethical Problems in Medicine and Biomedical  and Behavioral Research. (1982). Making Health  Care Decisions. Wash, DC: Gov’t Printing Office.