Strong GP voice required to define quality – Dr Mary Beth MacIsaac

We need to talk about defining quality in general practice.

Although talking about quality of general practice often induces feelings of boredom mixed with apprehension, we need to talk about it on a grassroots level as well as a leadership level. Formal definitions can be tricky – trying to define quality without using the word quality is a frustrating exercise.

However, we know quality when we see it. We know who the ‘good’ doctors are and where the ‘good’ practices are – a quick litmus test would be: would I trust my mother’s, partner’s or child’s care to this doctor?

There are some common factors that signal quality: good patient-doctor relationships, whole of person care, clinical reasoning ability, and management that takes practical considerations into account.

Measuring these factors is particularly difficult and relies on mainly qualitative assessments. However, measurement of quality and quality improvement are topical issues given government initiatives such as the QI PIP and data extraction.

It is reasonable that both government and patients would want to ensure that healthcare is of high standards.

However, my concern is that without a strong GP voice, quality definitions will rely on the measurable, and particularly the easily measurable (quantitative) factors. The issue with quantitative data is that it doesn’t, and can never, tell the whole story.

General practice is complex, variable, and non-linear. It is not a process that lends itself as easily to quality improvement as surgical infections, for example. We therefore need an answer for those who would like to define general practice as a simplistic, quantitative, transactional system.

This answer includes definitions of quality that are as nuanced, complex and variable as general practice itself. This issue affects all of us because it goes to the very heart of general practice and the way we practice medicine.

We need to define what it is we do, and what it looks like when we do it well, before we have it defined for us. Otherwise, we may spend our work lives chasing targets that get in the way of good patient care.

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