Park, S; Swinglehurst, D; Emmerich, N; Maybin, J; Quilligan, S; (2013) The Many Meanings of Quality in Healthcare. Cumberland Lodge Colloquium. Cumberland Lodge

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Abstract

This conference brought together academic scholars, healthcare professionals and lay representatives to reflect on the notion of ‘quality’ in healthcare. Delegates represented a wide range of disciplines including: medicine, nursing, social sciences, philosophy and ethics, sociolinguistics, health and social policy;anthropology;media and arts;medical education. In the opening keynote lecture, Dr Iona Heath reflected on the tendency of quality initiatives to address the human being as an object, thus marginalising the subjective experience of illness and care-giving, with unwelcome consequences.Three parallel streams of oral presentations followed, organised by conference themes: • Professionals and patients: collaboration and communication in delivering quality healthcare. • Improving quality of care: management, governance, standards and accountability. • Professional values and their relationship to quality in healthcare. The second keynote speaker, Dr Jocelyn Cornwell, discussed patients’ experience and human factors in healthcare delivery and policy. Offering insights into why failures of care might arise, she suggested approaches which may ensure that both the relational and transactional elements of patients’ experiences are addressed in complex healthcare environments. A series of interactive workshops followed, including one focussing on patients’ experiences of care and the meaning of ‘recovery’ in the context of chronic disease and addiction. Another considered the challenges of practice from a creative perspective.Throughout the day, delegates viewed research posters and exhibits of reflective writing and artworks.The event ended with philosopher Dr Havi Carel speaking about epistemic injustice and epistemic virtue in healthcare. Delegates reflected critically on whether, how and to what extent current efforts to achieve quality of care are successful. A number of key interrelated themes emerged. Many presentations highlighted a range of important tensions as relevant to the meaning of ‘quality’. Delivering healthcare involves oscillating between a range of different (and apparently contradictory) notions of‘quality’− a delicate balancing act.An important aspect of professional practice is that of working creatively with these tensions, exercising judgements in particular situations of care. Supporting such professional practice requires robust organisations which are stable enough to foster relationships of professional trust, but flexible enough to allow for this responsive, creative work. A second theme to emerge was a call for more description and less measurement. Attempts to measure quality of care were regarded as unreliable, and many delegates expressed concern that current quality initiatives focus too readily on those aspects of care which are measurable, risking the marginalisation of ‘humanity’ in healthcare.The importance of description and narrative to engaging affectively with patients’ experience was seen as important not only to patient care, but also to research and education. There was concern that the time and space necessary for innovative, creative approaches to delivering excellence in care were being ‘squeezed out’ and replaced by a range of ‘quality’ initiatives which sit uncomfortably alongside professional conceptions of excellence.Learning to think critically,reflect on practice and act morally was identified as the key to delivering quality care. It was suggested that greater value be given to educational activities which encourage an examination of practices with these in mind. Finally, the word ‘trust’ sat alongside ‘quality’in many colloquium discussions.A fragile phenomenon, it was identified as centrally important to both professional−patient relationships and professional team-working

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