By Jim Williams, President and CEO
Oklahoma Foundation for Medical Quality

Quality means different things to different people.  Quality in health care is no different, and defining and measuring quality can be challenging.  This definition may help simplify it:  Quality in health care can be defined as “every person receiving the right care at the right time.”  

One way to think about quality is your satisfaction as a customer. Your satisfaction may depend on things like seeing the doctor on time, being treated well by staff, or how you feel about being called by your first name.  We all want and expect to be treated kindly, respectfully and efficiently by our health care practioners. 

Another important aspect of health care quality is getting the right medical care.  How well did your doctor or other provider treat your medical condition and provide preventive care?  Quality in medical care can be evaluated by “professionally recognized standards,” meaning that the care you received was similar to what would have been given to you by most doctors. Put another way, did the doctor or provider use their best judgment in applying professional guidelines to treat you specifically and avoid harming you? 

Examples of medical care that does not meet “professionally recognized standards” include:

• Being given the wrong medication, or a medication to which you are allergic, or medications that interact in a negative way.
• Not receiving treatment after abnormal test results.
• Being given the wrong blood when a transfusion was ordered.
• Sustaining a serious injury resulting from a fall while in a nursing home or hospital.
• Being improperly evaluated for a problem and because of this not receiving the treatment you needed.
• Being given treatment that is wrong or treatment that you did not need.
• Developing bed sores because you were not moved regularly.

A bad outcome may or may not mean substandard care, or poor quality.  Complications or risks associated with your condition or procedure could result in a bad outcome even when care met “professionally recognized standards.”

The health care community continually makes changes to improve the quality of medical care you receive. For example, your doctor may use electronic health records to track your care. This lets him or her see all of your medical records, be more proactive and make better decisions about your care. The staff in your doctor’s office may have developed new procedures to make sure you get the right care for someone of your age or with your condition. Or maybe the hospital staff does something as basic as marking the part of the body to be operated on, preventing a potential medical error.

Because human beings are imperfect and make mistakes, developing and using systems like this is very important to make sure patients receive quality care.  Healthcare providers all over Oklahoma, in hospitals, nursing homes, physician practices and home health agencies are working hard at improving quality and making health care better in our state.  

Be Your Own Advocate

Healthcare experts have long advised that patients and their loved ones have a role to play in ensuring they get quality health care.  Contact Medicare at 1-800-MEDICARE (1-800-633-4227) any time you have a concern about the quality of care you or a loved one receives. Medicare will refer you to Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization in Oklahoma. 

OFMQ has professionals who review what happened to you.  The review process involves looking at the information contained in your medical record to determine if there is evidence of substandard care.  If a problem is found, these professionals work with doctors and health care providers to find ways to improve the care they give.  Voicing your concerns is important.  By following through on your issue, your call can help Medicare improve health care for others.

You might think that a healthcare provider would be unhappy to learn that an outside organization was checking on the quality of the care it delivers.  However, the opposite is usually true.  In fact, healthcare providers often welcome outside help on quality issues.  They understand that even the best provider has to continually check the ways things are done to ensure quality stays high and improves when possible.    

Back to customer satisfaction, for a moment.  Sometimes, people have concerns that don’t fall into the category of not meeting “professionally recognized standards”.  If the concern did not result in harm or risk, mediation may be a choice. Mediation brings together the doctor, hospital, healthcare provider and Medicare patient for a face-to-face meeting led by a neutral third party (mediator). 

Lack of communication and misunderstandings between patient and provider are often cause for concern and are ideal for mediation.  Mediation is a good way to discuss these emotional topics and can give closure to an upsetting event.

OFMQ’s services are provided at no charge to Medicare beneficiaries.  We can help you navigate the process of resolving a quality of care concern.  Our website has more information on our services as well as links to many resources for Medicare beneficiaries.  Access the consumer section at www.ofmq.com. 

This material was created by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for the state of Oklahoma, under contract with the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health of Health and Human Services. Contents do not necessarily reflect CMS policy. 3A-017-BPARTICLE-OK-0907