How can you measure care?

It has just been revealed by the Health Services Journal that Sir Mike Richards has been appointed as the new Chief Inspector of Hospitals. The purpose of this unenviable role has been described by David Cameron to ensure that “a hospital is clean, safe and caring, rather than just an exercise in bureaucratic box-ticking”.

The ‘clean and safe’ bit is relatively simple to monitor. There are a multitude of matrices available to set and measure performance standards, clinical outcomes and achievement of targets. But it is the care bit that’s tricky.

The new Chief Inspector, whose team will become part of the Care Quality Commission (CQC) has said that he ‘will champion the interests of patients’. This laudable aim fails to provide a definition of how to measure those interests so I looked to the CQC for clarification. Their website states their aims related to hospitals and GPs as:

‘We check all hospitals in England to ensure they are meeting national standards, and we share our findings with the public…..We inspect GP practices and other primary medical services in England to check that they are meeting the national standards of quality and safety’

It is absolutely right that national standards of quality and safety are met and monitored on a regular basis. But we still don’t have a benchmark for care.

Emotional intelligence is becoming an accepted principle for describing individuals, departments and organisations. One model to assess emotional intelligence is based on the three I’s – Intention, Interpretation and Impact. If you imagine a ward or GP surgery environment it is logical to project the three I’s to measure care and I would like to see this explored on a more formal basis for the NHS.

In the meantime, of course patient feedback and the ‘friends and family’ test are a valuable tool, albeit a subjective one. But then – care is subjective isn’t it?

Always happy to hear good news healthcare stories I am pleased to have two to report this week. One of my daughter’s colleagues is facing the agony of a very premature baby, born at 26 weeks, fighting for survival in a hospital in Portsmouth. The baby’s father has said that the one thing he doesn’t have to worry about is the care. A nurse is by the baby’s incubator at all times and the precision and intensity of each procedure (such as taking blood samples form underdeveloped veins) is enhanced by the palpable desire of each doctor, nurse and therapist for the baby to survive and thrive. The baby’s parents are in no doubt of the genuine commitment and care of the team who hold this precious life in their hands as medicine and care are combining to give this little mite the best possible chance.

Another example of care is much more low-key. Regular readers of this blog may recall my account of a gentleman (Tom) who was receiving poor care in a ward after breaking his hip. (‘Good care is about personal responsibility’ 21 April). Suffering bed sores, missing meals because he couldn’t reach his food, and becoming more frail by the day, the poor care received was having a direct impact on his will to live. I am pleased to report that Tom’s wife arranged for him to be moved to another hospital where the ward delivered the sort of care every patient should suspect. The medical treatment was the same, but the emotional and physical care was clearly far superior in this second hospital. Little things like making sure his cup of tea was just how he liked it, alongside scrupulous cleanliness and appropriate treatment for his bed sores. Tom is now home – working hard on his exercises and looking forward to walking his beloved dogs again before too long. What a difference moving from an environment with a poor emotional intelligence to one which embodied positive physical and emotional support.

I shall leave the last word to Tom’s wife – who used her own personal benchmarking system:

‘You could feel the care the minute we walked in the door’