A few years ago I was invited to a South Asia/Pacific regional conference in India to speak about the approach to quality being taken by the organised health consumer movement in Australia. I was apprehensive about the task. Most of the countries represented were developing countries and many of them were reputed to have poor access to even elementary healthcare. Why would they be interested in our views of quality? And even if they were interested, how useful would the results of consultations with consumers in Australia be in their diverse settings?
My concerns were unfounded. It became quickly apparent that consumers and public health workers in developing economies had no intention of making the mistakes we have made in OECD countries. As they see it, we have worked for access and availability at the cost of quality. They intend to work for access to quality.
The people at that conference shared the issues that we had found in our consultations in Australia. Users of health services want safe, appropriate interventions, treatment and care. We want to be treated with dignity and respect.
We want information that is accurate, timely and relevant. We believe that if this is to happen then consumers must be involved and consulted, not only in relation to their own healthcare, but also about service planning and delivery, health evaluation and research.
To say that patients want safe, appropriate treatment is most obvious. We have all heard stories of the surgeon who performed very successful surgery, but amputated the wrong leg or removed the healthy kidney. Many errors are avoided because of intervention or questioning by a consumer or carer. Errors increase when we are not heard.
At a recent enquiry in my locality, it transpired that two daughters of a patient questioned the blood that was about to be transfused as not being the same as their mother¡¦s blood type. Their concerns were ignored and the patient died. Aside from sanctions and litigation, who really is affected by such an error? The consumer. Health professionals often argue that consumers are not in a position to make judgements about technical competence. Maybe so. But if we judge technical competence by outcomes, then surely consumers are the best judges. Yet who currently designs the performance indicators?
And who is to judge whether there has been dignity and respect in the treatment and care process? Surely, only the consumer. Only consumers can determine whether they have received information that meets their needs.
The closest most health services come to measuring these consumer experiences is the occasional satisfaction survey. But I have yet to see a health service that encourages complaints and fully uses them as a quality improvement tool. Targeting a reduction in complaints is not a sign of improvement. What is needed is an effective evaluation of the accessibility of complaints procedures and the introduction of incentives, such as feedback and proof of real action, to encourage and support complaints.
It is difficult when we are sick and vulnerable, to be faced with a health professional who, at least in our perception, has greater knowledge and power. Alas! Consumers have no professional or employment base from which to lobby for their interests. So to participate as equal partners they need to be able to consult, to develop policy and strategies and to train for their advocacy role. At that conference in India participants from developing and developed countries agreed that consumers, through their organisations, should have the resources to participate in all health planning and research. Only then will we stand a fighting chance of creating quality health services.
* Janne Graham is a consumer representative and a former chairperson of Australia¡¦s unique national health consumer organisation, Consumers¡¦ Health Forum. Ms Graham has recently recovered from an iatrogenic condition (pulmonary oedema/cardiac failure) following admission for cellulitis.
• Graham, J. D., "India in December: A Report on a Consumers' International Consultation", Health Forum No. 40, February 1997.
• Parker, M., "The Ethics of Evidence-based Patient Choice", Health Expectations, June 2001.
©OECD Observer No 229, November 2001