The following is a letter I wrote to the editor of Quality Progress concerning consumer preferences and the objective and specialized criteria of quality healthcare; the type of healthcare we all need.
The reason Roger Kidd (“Inbox”, July 2010) “can’t believe [Quality Progress] would put [quality manager] Donald Berwick on a pedestal” as a superb choice to head up critical aspects of the Obama administration’s healthcare reform effort is because Kidd doesn’t understand the role of consumers in quality management. He says “consumer preference is the cornerstone of quality”. This is not correct. Deming, Juran, and many other quality management thinkers and practitioners have made it quite clear that quality products—not consumer preference—is the cornerstone or foundation of quality. Quality products meet objective, measurable, criteria; in the case of healthcare, the criteria or standards of physicians, hospital administrators, and other specialists in the healthcare profession; people like Donald Berwick and Janusz Godyn, M.D. “Quality of [health]care”, Godyn writes, “is the objective measure of the outcome and the objective evaluation of the most effective ways to achieve the best outcome. This . . . should be scored by professional experts based on the current knowledge”. (Quality Progress, July 2009, “Dare to Care”, p. 36.) Whereas quality products are objective phenomena produced by specialists, preferences are subjective phenomena produced by socialization in all its variations, including schooling, peer pressure, advertising, and political propaganda. Consequently, most consumers are unlikely to prefer or choose the healthcare they actually need. They have the right to choose but, for the most part, they don’t have the ability to choose wisely. Patients in hospitals and citizens trying to decide which healthcare insurance policy to purchase don’t know how to diagnose and treat their illnesses nor do they know the best way to deliver or implement the most efficient and effective healthcare policies, or the optimum way to pay for the care they need. Consumers of healthcare will receive the healthcare they need only when they receive quality healthcare. Only quality healthcare—which is true for all quality products—has “fitness for use” (Juran, Juran on Leadership for Quality, p. 15.); only quality healthcare fits consumers’ needs.