Quality is Not an Accident: The Planning for a Safe Journey Through the Healthcare System

Introduction

A culture is perhaps most simply defined as the interaction of what people take for granted. Growing up in countries around the Mediterranean, I learned the importance of knowing what people took for granted. From “destiny will decide if you will have a child” to “big fish eat small fish”, culture was the environment within which we accepted, changed, or celebrated what we had. But the most important lesson I dearly cherish is the conscientious effort I make not to immediately challenge what is believed to be right or wrong, for that is what people take for granted.

This was (and remains) my guiding principle when, like many others, “accidentally” I became involved in the field of quality in heath care. Accidentally, because in 1982 I was a junior field epidemiologist in an Arab country in the Persian Gulf involved in helping the Ministry of Health build a national healthcare information infrastructure as well as construct primary care centers based on the “reservoir of need”, mainly involving maternal and child care. After establishing a baseline of need, the population distribution helped decide where to locate the centers. After a few months, we looked at utilization patterns in the centers. One center had a higher utilization rate than expected, and we decided to find out why. Since I spoke Arabic, I volunteered to interview patients and providers. When I entered the “Women and Children wing” of the center, I saw children running around and playing as if in a playground. Mothers, wearing the traditional Arabic dress, had most of their bodies covered, showing only their eyes, hands and feet. I approached one mother and asked what brought her to the health center. She told me she comes here every day, “mostly for a back pain”, and added that her 4 children always come with her. When I asked if her back pain was getting better, she said “may be, God willing it will be fine.” When I pushed more about the real reason for her visiting the center, she looked at me in surprise and said “but this is the only place in the desert that has cold water fountains and air conditioning!” I realized that we had built community centers not primary care clinics. And that was the “accident” which brought me to quality in health care.