There’s more to quality than five stars


There’s more to quality than five stars | Texas Children's Hospital
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I recently received an email from a "review concierge," which provided me with my "review report card" (I got an A!) and offered their services to help improve my grade so it would "truly reflect [my] quality of care." The existence of a company solely focused on enhancing physician online reviews certainly highlighted the exponential growth and popularity of online web reviews and social networking. However, the idea patients would utilize these sites as a primary source when researching and seeking "quality" physicians and hospitals worried me. Health care quality is not only defined by the patient experience, but also by numerous other factors, including evidence-based practice utilization, treatment outcomes, safety procedures and coordination of care. 

Health care quality consists of two distinct, but overlapping components: technical and service quality. Whereas technical quality consists of care characterized by commitment to using the best scientific and clinical information available in the service of the patient, service quality involves the myriad of characteristics that shape the experience of care for each patient and their loved ones. Because many patients may not feel qualified to judge the "technical" aspect of care, they instead assess their health care by other dimensions that reflect what they personally value, such as how they're treated as a person versus their symptoms or condition. The distinction between these types of quality is important because online review web sites most likely reflect the service quality (i.e., wait times, facility appearance, communication, etc.) of the physician or hospital, and although it's an extremely important aspect of care, it's only "one slice" of the quality pie. 

If you're looking for a new physician or health care facility, it's important to do your research. The health care system is not easy to navigate, and although logging in and googling might be an easy and convenient approach to finding potential options, it's not necessarily the best of safest way to research potential resources for you and your loved ones. Once you've identified your (or your child's) medical needs, follow these steps.

1. Compile a list of potential physicians and hospitals

  • Ask your family and friends about their past experiences and recommendations. Because they personally know you, they may be able to suggest a physician or hospital that would best fit your medical needs and expectations.
  • Find physicians through the closest academic hospital or medical center's web site. Most physicians can be searched for both by their specialty and academic/research interests.
  • If you or your child has a specific medical need (i.e., congenital heart defect, diabetes, etc.), search for the top physicians and programs that regularly care for and successfully treat similar patients. 
  • Review this list in your medical plan. Health care is expensive, so making sure your insurance covers the costs is extremely important. 

2. Research the physician

  • Check the physician's credentials, including the validity of his/her medical license, years in practice and any previous grievances/disciplinary action. Most of this information, including the physician's medical school, residency and fellowship programs, can be found on your state's medical board web site. For Texas, click here.
  • Even though board certification isn't required to practice medicine, it demonstrates a physician's "exceptional expertise" in a particular specialty and/or subspecialty of medical practice. To verify the physician's board certification, go to the web site for the American Board of Medical Specialties.
  • Review consumer, government and medical plan web sites for physician and medical practice quality and performance measures. 
  • Ask the physician about hospital affiliations and privileges (or hospitals where he/she admits patients), clinical and research interests, availability of appointments and after-hours support. 

3. Research the hospital

  • Ensure the hospital is accredited by the Joint Commission, an independent, nonprofit organization tasked with evaluating and accrediting nearly 18,000 health care organizations and programs throughout the nation. Through on-site reviews, the Joint Commission ensures the health care organization is meeting certain quality performance standards. You can find accredited organizations here
  • Look for hospitals with magnet designation, an award recognizing health care organizations for "quality patient care, nursing excellence and innovations in professional nursing practice." You can find magnet-designated organizations here.
  • Compare hospital quality measures on consumer and government web sites like Hospital Compare, which publishes quality measures at over 4,000 Medicare-certified hospitals across the country. 
  • Ensure the hospital has expertise with you or your child's condition. Review state, consumer or hospital web sites for performance measures, such as the number of patients treated or procedures treated annually, complication and readmission rates, mortality rates and long-term survival rates. Texas Children's publishes their quality measures here

Word-of-mouth is probably the most powerful marketing tool in health care, and many online companies and "review concierges" are more than willing to offer their services. Although a pattern of service quality can be gleaned from other patients' perspectives and previous experiences, further investigation should be performed before choosing or dismissing a physician or hospital. It's important to remember that many people tend to leave critical comments or reviews when they've had poor experiences as opposed to positive ones, so keep in mind that this might potentially skew your perception while you search. Be persistent in your pursuit for quality excellence - the amount of time and effort you put forth towards finding the best physician/hospital for you or your child will be well worth it!