Wednesday, January 06, 2010

Health service is not as sickly as we are told

I've been waiting for someone to do this for a while. The Irish Times journalist Sarah Carey writes a story about her positive personal experience with the public health service. The article highlights the high standard that the Irish health care system has reached and offers noteworthy suggestions as to why public perception is misconceived.

Its always nice to see a journalist write the truth and enlighten, rather than pander to their readers. It's a pity its so rare.

I wonder if the Irish appetite is more sickly than we're told?


Liam Delaney said...

Though this is a sample size of one Peter (two if we count you) so let's not get too carried away.

I think the point you raise is a good one though about what standards we expect from the health services. There is no such thing as an absolute measure of "good" or "bad" so a lot of the public debate becomes an argument with hidden thresholds built in. Gary King, who developed vignettes for stats applications, has recently been arguing that a conceptual framework based on vignettes should be used for clarifying debates in these types of areas.

Kevin Denny said...

I haven't read the article beyond the first line but as Liam indicates it is an anecdote and therefore, I would say, useless. In fact worse than useless because people may think you can infer something from it when you cannot & the journalist in this case is someone I have a lot of respect for. I am sure one could also line up people who could give you horror stories. Where does that leave us?
The problem with medicine (& this is one reason why I wouldn't do research on health services) is that people have very visceral feelings about it. You come into contact with the system when you or a loved one is unwell.
If a death is involved then feelings are obviously stronger. So whether you have a good or bad experience it is impossible to discount it, no amount of stats will cause you to change your mind. A similar issue arises with education though its not as bad.
So I was admitted to A&E a couple of years ago. It was all a bit traumatic (don't worry folks I'm fine, false alarm) but because I was looked after pretty well I have a rather benign view of the system: I can't get it out of my head (as I believe Kylie put it).

Liam Delaney said...

To bring in some statistics, I advised on the HSE satisfaction survey led by Professor Cecily Kelleher a few years ago (link below).

It wasn't that surprising to me to see relatively high levels of satisfaction. No-one believes that most people entering Irish hospitals are having bad experiences. However, with healthcare the importance for people is so high and the salience of a bad experience so great that even a 5-10 per cent negative rate is a lot.

Mark McG said...

There are good reasons to highlight bad experiences even if they are untypical, although the article raises good points about reporting in the media.

Vignettes are undoubtedly useful for subjective measures but I wouldn't ignore the importance of knowing how we compare to international best practice or whether hospitals meet agreed targets on objective indicators. Health Stat, which was launced last year, is an excellent development in this area.

"HealthStat is a comprehensive databank of performance information from Irish public health services. It currently provides detailed monthly results from 29 teaching, regional and general hospitals, which are published online."

Liam Delaney said...

HealthStat is certainly a step forward. I am hoping someone will actually begin to analyse the data. I would do it if it were available in STATA form

Kevin Denny said...

Making this information available would be like making information available on schools. Crude league tables on schools are evil, simplistic, brutish philosophy of education blah blah... Ergo it cannot be right.
(I'm being sarcastic, lest you be in any doubt).

Liam Delaney said...

Information is available kevin. They actually published some crude league tables recently.

Peter Carney said...

I can assure you that I'm not usually taken in by anecdotes but this one did stoke a feeling that i've been having for a while, and one that is clearly familiar to some of you. That is, the fact that 1,000s of people enter the health care system everyday, get treated, and nursed back to unambiguous health without the slightest mention. As a public service, these are real achievements and yet we (or at least the media) choose to completely overlook them - not even a peep, it never raises it's head.

The article by Sarah Carey is worth reading in full. It shines light on reasons for a political flavour for a struggling health service, and the vested interested that work to make a gray area (in terms of absolute measures) pitch black. Sarah Carey is on to something important here; she's more of a reality-checking whistle-blower than an outlying anecdote.

Health care workers, and the system as a whole, could well benefit from less berating and more (honest) positive reinforcement and encouragement, if only to be fair. Even more so now in a climate of significant wage reductions and weakening worker morale in the public sector.

The visceral nature of medicine, and indeed the apparently natural 'car-crash' interest people take in it, should not derail the honest truth of the situation. If anything it reinforces the need to publish (not torture) the relevant statistics.

Furthermore, I honestly don't believe that we have anything to fear about medical league tables. Medicine, unlike education, is a Science - there is generally a right way and a wrong way. I've read (Nudge, or it's website) that hospital morality league tables can work wonders for patients.

Liam Delaney said...

Sure - but develop the point. If your argument is that the Irish public health system is operating efficiently, what metrics could you employ? The OECD health tables are one source you could use. Would be interesting in seeing a post at some stage trying to make the case with some numbers.

Liam Delaney said...

One final point I have is that it is not illegal to do some advocacy at times if you believe you are correct, so if you really believe that the health system is being undermined by flawed reporting of its defects, it is not a crime to try to defend it.

I am struggling with this myself. No-one listens if you keep the gentleman's gloves on yet you don't want to demean the literatures you are drawing from by sensationalising them. There is a balance somewhere.

Peter Carney said...

I agree that we need data to continue the debate; I'll look into it further.

The standard practice of relying on negative anecdotes and trade union reports will have to continue for now.

Sarah Carey said...

Hi all - permit me to intrude on the conversation :) I fully accept the problem anecdotes bring to debate, but my experience made me realise that perhaps our weaknesses in health are not political or financial, but one of management. If some departments in some hospitals can get it right, then we need to look closely at what they're doing and replicate it. I think that's the real lesson. By defining "health" as a big problem that must be solved by big ideas (and big negotiations with big money and big rows!) it could be about solving little problems, hospital by hospital. It's a smaller bite sized approach to improvement, but having witnessed excellence within a supposedly broken system, I think its an approach that has merit.

Peter Carney said...

Sarah, thanks for your comment.

I think the bite-size suggestion has a lot of merit - it is reasonable to assume that some hospitals have a higher level of efficiency and quality than others and investigating their management models would be insightful. I understand the Health Information and Quality Authority (HIQA) have the functions capable of achieving this and the HSE's own HealthStat signals a move in this direction. The potential role of league tables is also something currently gaining ground.

When we define and talk about 'health' we need to be careful. Societal health and well-being is more than the sum of its efficient hospital and health professionals. I expect most will acknowledge this but the distinction between 'public health' and the 'public health service' is vitally important and deserves greater consideration in the Media. How people think about health and public health is greatly influenced by the Media but often the Media's definition never gets beyond hospital waiting lists. It is hardly surprising then that there isn't appropriate political will or support for disease and chronic-illness prevention, and health promotion programs and policies.

Ireland has proven itself to be innovative, brave and widely successful in public health policies - the smoking ban, for example, is a beacon of success worldwide with untold 'health' consequences. There are many other simple (and more complex) public health initiatives that could potentially have great health benefits and which deserve greater attention.

I believe the Media could do a much better public service if they deliberated a little more on health and obsessed less about sickness and our blogging colleague :-) Sarah Carey should be acknowledged for achieving this.