COMPETENCE ABOVE ALL


The first principle of health care is to “first do no harm”. In the complex system that we live we seem to have forgotten to whom we are responsible. The duty of care and the equitable distribution of such has taken a back seat.  The comfort of the staff is vital but their competence is far more important to our patients. Many seem to believe that our staff members being “nice” is the key to care. ThIs misguided notion is taking us into the weeds and missing the real problem in many institutions. Our real problem is competence and consistency. If the goal of our system is to provide consistent and dependable care we must first stand up for equity. The equity I mean is equity of care standard.

The care delivered varies wildly and the reason for such disparity is as varied. Fortunately many institutions have noticed the problem but their solutions seem worse than the problem. The government has stepped in because we have not consistent applied the care we know to be best. The government has used the same consumerist benchmark of satisfaction that is used in retail sales as a proxy for care delivered. This approach is sub-optimal at best. It is not likely to be the best measure. However, our opposition to these measures will not improve patient care. What we need to recognize is that patient satisfaction can be a good proxy if we work in a system where competence is priority number one.

Patient satisfaction is a complex fickle beast. We cannot practice from the point of providing a ‘satisfying’ experience. Our care should be directed at proving the best outcome to all. The only way to provide such care is if our systems are focused on designing best in class care systems and staffing such systems with competent staff. In recent years our systems has fallen into the sad and despairing state were we have lost focus on care and the competence of our staff. The misguided first basis focus on the social behaviour of the staff is driving the best out of the system and putting out patients at the mercy of the less competent, but ” nice”.  If our purpose is best in class care and superior outcomes there is only one matrix that matters. We must provide our patients with the best trained staff. Our efforts must be evidence bases and physician driven.

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