Global Report Calls for Urgent Interventions to Improve Healthcare Quality

Low quality healthcare costs time and money, notes a new joint report by the Organisation for Economic Co-operation and Development (OECD), the World Health Organization (WHO), and the World Bank. Poor quality health services are holding back progress on improving health in countries at all income levels, not just low- and middle-income countries, the report said.

The report is a guide for governments around the world to think seriously about planning for high quality care, keeping the goal of achieving universal healthcare by 2030 in mind.

“Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge,” says the report, Delivering Quality Health Services — a Global Imperative for Universal Health Coverage.

“Without quality health services, universal health coverage will remain an empty promise,” OECD Secretary-General Ángel Gurría said in a statement. “The economic and social benefits are clear and we need to see a much stronger focus on investing in and improving quality to create trust in health services and give everyone access to high-quality, people-centered health services.”

Findings in the report show a range of quality problems in healthcare around the world:

• Around 15% of hospital expenditure in high-income countries is due to mistakes in care or patients being infected while in hospitals.
• OECD data from high- and middle-income countries show that 19% to 53% of women aged 50—69 years did not receive mammography screening, and that 27% to 73% of older adults (age 65 years and above) did not receive influenza vaccination.
• Healthcare workers in 7 low- and middle-income African countries were only able to make accurate diagnoses one-third to three-quarters of the time. Clinical guidelines for common conditions were followed less than 45% of the time on average.
• The Service Delivery Indicators initiative in 7 low- and middle-income countries showed significant variation in provider absenteeism (14.3% to 44.3%), daily productivity (5.2—17.4 patients), diagnostic accuracy (34% to 72.2%), and adherence to clinical guidelines (22% to 43.8%).
• A systematic review of 80 studies showed that suboptimal clinical practice is common in both private and public primary healthcare facilities in several low- and middle-income countries.
• Research in 8 high-mortality countries in the Caribbean and Africa found that effective, quality maternal and child health services are far less prevalent than suggested by just looking at access to services. For example, just 28% of antenatal care, 26% of family planning services and 21% of sick-child care across these countries qualified as “effective.”

The economic and social costs of poor quality care, including long-term disability, impairment and lost productivity, are estimated to amount to trillions of dollars each year. However, there has been some progress in improving quality, for example in survival rates for cancer and cardiovascular disease.

The 100-page report outlines the steps governments, health services, and their workers need to take to improve healthcare quality.

There are 5 foundational elements critical to delivering quality healthcare services, the report said, including healthcare workers; healthcare facilities; medicines, devices, and other technologies; information systems; and financing.

Interventions to improve care quality include:

• A quality policy and implementation strategy as part of the formal health sector national plan
• A quality policy document developed as a stand-alone national document
• A national quality implementation strategy, including an action agenda and essential policy areas
• Enabling legislation and regulatory statutes to support the policy and strategy.

Health systems should focus on competent care and user experience to ensure confidence in the system. Healthcare workers should see patients as partners and commit themselves to providing and using data to demonstrate the effectiveness and safety of healthcare.

Among other things, health systems need to:

• Implement evidence-based interventions that demonstrate improvement
• Benchmark against similar systems that are delivering best performance
• Ensure that all people with chronic disease have a high quality of life
• Provide technical assistance and knowledge management for improvement