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INTRODUCTION

Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction, and skillful execution.

 —WILLIAM FOSTER

 

Unless you are in a commoditized business in which offering the lowest price is the only essential component of your success, you have to consider how consumers perceive the value of your offerings. In most businesses, value can be calculated by combining the perceived quality of the products or services with the perceived quality of the consumer's experience and then subtracting the price charged for those goods or services.

Value = (Perceived Quality of Product + Perceived Quality of Service Experience) – Price

If consumers believe that the combined quality of the product and the experience exceeds the price, they impute positive value; if they do not, they feel fleeced.

In healthcare, this standard value calculation doesn't fully apply. Given that the "price" of healthcare is less obvious to consumers (particularly when payments are made through third-party payers such as private insurance or Medicare/Medicaid), a patient's perceived value can almost be reduced to, "Did I get the best outcome, and how was I cared for along the way?" Trends suggest that price transparency, cost/outcome statistics, and even patient satisfaction have become increasingly important components of calculating "value" in healthcare, and certainly these issues have been central in political conversations on healthcare reform. However, historically, from a patient's perspective, healthcare quality has had less to do with cost and more to do with outcomes and the process of care.

This chapter and the next offer insights into how UCLA's leadership consistently drives quality at both the product and the experiential levels. This chapter offers definitions of quality and an examination of the relationships among quality, patient outcomes, and ease of healthcare access. The next chapter will look at UCLA's quality in the areas of efficiency, equity, technology, and comfort. In the highly competitive world of business, a dedicated commitment to quality improvements at both the product and the service level is often the key to gaining competitive advantage; in healthcare, it can be the difference between favorable and unfavorable patient outcomes.

HEALTHCARE QUALITY DEFINED

It has often been said, "I don't know much about art, but I know what I like." A similar sentiment could be shared about healthcare quality. Consumers have difficulty evaluating the real success of complicated medical procedures. It is also challenging for patients to assess how a particular patient's outcome after receiving care from a given provider compares to the outcome of a similar patient with a similar condition who received care from a different provider. To better understand the unique intricacies involved in healthcare quality, let's examine attempts to define medical excellence. The federal Agency for Healthcare Research and Quality (AHRQ) simply defines exceptional healthcare as "doing ...

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