Making Quality Count

In medicine, there is an important distinction between clinical quality and perceived clinical quality. They are rarely one and the same, and understanding this distinction is critical for both clinicians and practice administrators.

Quality, like beauty, lies in the eyes of the beholder. In medicine, there is an important distinction between clinical quality and perceived clinical quality. They are rarely one and the same, and understanding this distinction is critical for both clinicians and practice administrators. 

Clinical quality is the collective sum of the patient care experience; it is not just a measure of how good a clinician you are. It is also a measure of the synergy that exists between the science and the art of medicine. The best clinicians are textbook solid and cutting edge current (the science side) but also have a sixth sense for honing in on the right diagnosis (the "art" of medicine). Trouble is, it is hard to measure excellent clinical quality.

Adherence to evidence-based care might be a fair gauge of clinical quality, but most practices do not have measures for it. Payers have their own measure: cost (and to be fair, perhaps some other measures). I think most physicians feel they know who the best physicians in their community are, yet it is hard to quantify these opinions.

Perceived clinical quality is the fallback; it is how clinical quality is "measured" in the absence of standard accepted measures. Your patients are not doctors, and many cannot distinguish between Johns Hopkins and John Hopper. They measure your quality in a number of ways that you may think are unfair; however they are important to understand.

Think about your favorite restaurant. The food is only one aspect of your overall dining experience. If you have to wait 15 minutes for a table even when you have a reservation, if your server takes 10 minutes to bring you a drink, or if your incredible food arrives 30 minutes late, your opinion of the restaurant's quality has taken a hit - and it has nothing to do with the quality of the food. Restaurants, like medical practices, are team efforts in which quality is the sum of the aggregate experience.

Your clinical quality is impacted by other forces. If your appointment scheduler is unfriendly, if your waiting room is dirty, if you are running an hour behind and no one apologizes to your patients and gives them the option of rescheduling, you are fighting an uphill battle. Your clinical quality, in the eyes of your patient, has already taken a hit. And even if you provide the very best clinical care on the planet, your perceived clinical quality will be lower.

Want to improve your clinical quality? Here's how:

• Ask your patients to candidly discuss their experience. Ask referring physicians and their staff members to candidly compare your office's performances to others. Listen, and then act. Your patients, your referring physicians, and the employees of your referring physicians are your best sources for great insights.

• Take a fresh look at your lobby and exam rooms. Are they clean? Are the magazines current? Are the furnishings and artwork fresh or stale? Old and dirty equals lesser quality.

• Set a high standard for you and your staff - try to get reports back to referring physicians within three days. Call referring doctors immediately to let them know of an abnormal finding.

• Thank referrers for their referrals. Don't forget to thank their staff as well. A simple thank you can go a long way to improving your perceived quality.

• Running late? Make sure your front office staff keep patients informed. Apologize to your patients for making them wait. Your acknowledgement that their time is valuable will work wonders.

• Hire a secret shopper, or ask a friend to be your secret shopper. Have them take a test drive of your practice from the patient's seat. What you learn may be enlightening.

• Be critical in hiring staff. Friendly and competent staff, though hard to find, are invaluable.

I do not believe that perceived clinical quality will ever be a valid substitute for true clinical quality, but I am a consumer. I know that my measures of quality, be it for a doctor or a restaurant, or even a new DVD player, are based more upon perceptions and collective experience. I also know that low customer satisfaction leads to more patient complaints and more lawsuits; several studies have documented a strong correlation. I therefore suggest that you look out for cues, accept that perceived clinical quality is important to your customers, and take steps to improve. It will, like it or not, make you a better doctor.

Lucien W. Roberts, III, MHA, FACMPE, is associate administrator of business development at MCV Physicians. He also consults with medical groups and health systems in areas such as compliance, physician compensation, negotiation, strategic planning, and billing/collections. He may be reached at