Quality healthcare: what consumers want

Page 32 

David Rooney

All people are consumers of health services. It is about time they were treated as such. Only then will quality be improved.

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.

References

• 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 




Economic data

GDP growth: +0.6% Q2 2018 year-on-year
Consumer price inflation: 2.9% Sept 2018 annual
Trade: +2.7% exp, +3.0% imp, Q4 2017
Unemployment: 5.2% Sept 2018
Last update: 13 Nov 2018

E-Newsletter

Stay up-to-date with the latest news from the OECD by signing up for our e-newsletter :

Twitter feed

Suscribe now

<b>Subscribe now!</b>

To receive your exclusive paper editions delivered to you directly


Online edition
Previous editions

Don't miss

  • Globalisation will continue and get stronger, and how to harness it is the great challenge, says OECD Secretary-General Gurría on Bloomberg TV. Watch the interview here.
  • OECD Secretary-General Angel Gurría with UN Secretary-General António Guterres at the 73rd Session of the UN General Assembly, in New York City.
  • The new OECD Observer Crossword, with Myles Mellor. Try it online!
  • Watch the webcast of the final press conference of the OECD annual ministerial meeting 2018.
  • Listen to the "Robots are coming for our jobs" episode of The Guardian's "Chips with Everything podcast", in which The Guardian’s economics editor, Larry Elliott, and Jeremy Wyatt, a professor of robotics and artificial intelligence at the University of Birmingham, and Jordan Erica Webber, freelance journalist, discuss the findings of the new OECD report "Automation, skills use and training". Listen here.
  • Do we really know the difference between right and wrong? Alison Taylor of BSR and Susan Hawley of Corruption Watch tell us why it matters to play by the rules. Watch the recording of our Facebook live interview here.
  • Has public decision-making been hijacked by a privileged few? Watch the recording of our Facebook live interview with Stav Shaffir, MK (Zionist Union) Chair of the Knesset Committee on Transparency here.
  • Can a nudge help us make more ethical decisions? Watch the recording of our Facebook live interview with Saugatto Datta, managing director at ideas42 here.
  • The fight against tax evasion is gaining further momentum as Barbados, Côte d’Ivoire, Jamaica, Malaysia, Panama and Tunisia signed the BEPS Multilateral Convention on 24 January, bringing the total number of signatories to 78. The Convention strengthens existing tax treaties and reduces opportunities for tax avoidance by multinational enterprises.
  • Rousseau
  • Do you trust your government? The OECD’s How's life 2017 report finds that only 38% of people in OECD countries trust their government. How can we improve our old "Social contract?" Read more.
  • Globalisation’s many benefits have been unequally shared, and public policy has struggled to keep up with a rapidly-shifting world. The OECD is working alongside governments and international organisations to help improve and harness the gains while tackling the root causes of inequality, and ensuring a level playing field globally. Please watch.
  • Checking out the job situation with the OECD scoreboard of labour market performances: do you want to know how your country compares with neighbours and competitors on income levels or employment?
  • Trade is an important point of focus in today’s international economy. This video presents facts and statistics from OECD’s most recent publications on this topic.
  • The OECD Gender Initiative examines existing barriers to gender equality in education, employment, and entrepreneurship. The gender portal monitors the progress made by governments to promote gender equality in both OECD and non-OECD countries and provides good practices based on analytical tools and reliable data.
  • Interested in a career in Paris at the OECD? The OECD is a major international organisation, with a mission to build better policies for better lives. With our hub based in one of the world's global cities and offices across continents, find out more at www.oecd.org/careers .
  • Visit the OECD Gender Data Portal. Selected indicators shedding light on gender inequalities in education, employment and entrepreneurship.

Most Popular Articles

OECD Insights Blog

NOTE: All signed articles in the OECD Observer express the opinions of the authors
and do not necessarily represent the official views of OECD member countries.

All rights reserved. OECD 2018