Questioning what ‘quality’ means in quality health care

When I became quality manager at Axis Health System nine months ago, part of my work became helping define standards of “quality.”

As this process got under way, I soon arrived at an understanding that quality was an entity that was somewhat illusive to pin down – especially as it pertains to treating the whole person by way of providing integrated health care, which is somewhat of a novel practice to begin with.

I started asking the question: What is quality health care? I approached patients and providers, community members and family – essentially anyone who’d listen. While I was hoping my inquiry would narrow the definition of quality; the exact opposite occurred. It seemed like I heard a different opinion or perspective each time I asked the question.

Making sense of the wide-ranging response data was the research equivalent of hopping on a rodeo bull in the middle of the ring – after it had been let out of the chute. Throw in the national debate about health care and arriving at a shared definition of “quality” started to seem like setting out to build a colony on Pluto – a proverbial long shot.

So to develop a better understanding of quality within an industrial process (as health care is an industry), I went back to my hometown roots – Detroit. Not literally, but in contemplating the industrial process of automaking, I started to think about the concept of “Quality In – Quality Out.” Measuring outcomes is a big focus of health-care reform. I thought I’d arrived at a potential key point of understanding, so I started thinking about the Pontiac Fiero, produced between 1984 and 1988.

When the Fiero was rolled out, its fiberglass body was much-heralded. Bowling balls were thrown against the car to display its resiliency – the dents magically “popped out” back to form. However, nearly 20 years later, while a neat concept model, few Fieros seem destined to make the Historic Car Registry. Pontiac’s focus on the exterior shell – not the “guts” of this model – appears not to have resulted in long-term quality for the Fiero.

Perhaps Pontiac missed something along the way. Maybe it got entirely caught up with the idea of producing a quality exterior – an outcome – and inadvertently became unfocused on other parts of the process; it seems to have missed some steps.

So what exactly goes into the process of providing health care that makes it effective from the patient’s perspective? What contributes to our knowing that we’re not driving a Fiero home from our last office visit, so to speak? We recently asked this question of 30 AHS staff members and patients. We then took the 10 most common responses and built a Web-based survey to expand this inquiry to patients everywhere. If you’d like to assign importance to parts of health care that ensure quality – from your perspective – please visit

I’ll share results of this anonymous, community-based survey next month. Thanks for reading, and I hope to hear from you soon.

Mark White is the director of quality for Axis Health System. Reach him at or (970) 335-2217.