Quality Improvement for Healthcare

Quality can be an ambiguous word when people approach from different perspectives. What makes a quality car? It could be how long it will last; how fast it will go; how much it can haul. What makes a quality movie? Answering this question might require us to differentiate between genres, such as horror, comedy, action, or drama. If the goal of the movie is to generate suspense, but it fails, then we might say it wasn’t high quality, even if it was somewhat enjoyable. When trying to understand what gives something its quality, it is helpful to consult a variety of opinions. We’ll likely find someone that offers a fresh perspective.

These two examples of cars and movies have an obvious connection to aesthetics. People consider how cars look, feel, smell, and sound. And movies can be described as beautiful, haunting, and cathartic. What about other contexts, like offices, schools, and healthcare? As a society, we have diminished considerations of beauty and aesthetics to an afterthought (if they are considered at all).

Alan Cribb and Graham Pullin highlight the value of aesthetic considerations for healthcare in their article, “Aesthetics for Everyday Quality: One Way to Enrich Healthcare Improvement Debates.” Since in the healthcare environment we’re not seeking beauty for its own sake, they frame their discussion around the concept of quality improvement (QI). They acknowledge that aesthetics plays a role in certain questions, such as healthcare architecture, but that it ought to expand into the QI discourse as well.

Cribb and Pullin begin their discussion with a concept from philosophy known as everyday aesthetics. Everyday aesthetics arose to demonstrate the pervasiveness of aesthetics in our daily lives. They refer to the notion of everyday aesthetics for two main reasons: first, to show that aesthetics does not have to be primarily focused on art; second, aesthetics should not be limited to a set of “special” experiences or contexts, but rather part of the daily experience of life. And once we see that aesthetics is interwoven in our everyday lives, then it follows that we should pay attention to aesthetic considerations for practical affairs and policy.

“…seemingly insignificant everyday preferences and decisions can have serious environmental, moral, social, political, and existential implications.”

from Everyday Aesthetics by Yuriko Saito as quoted by Cribb and Pullin

To describe how aesthetics would improve quality in healthcare, they appeal to two different contexts: material and social. Beginning with material, they begin in a perhaps surprising place: medicine. They mean tablets, infusions, creams, and ointments. How these things appeal to the senses is extremely important, according to Cribb and Pullin. Some people might think it’s odd to wonder about the aesthetics of medicines because what really matters is the active ingredients, regardless of how something appears to the senses. In a technical sense, this idea contains some truth. But they explain, “In the real world, especially in a world where healthcare is seen as about the interaction of biomedical and human factors, these aesthetics reactions cannot be pushed outside of conceptions of technical quality.” (3) People trust the quality of a product more when it is more aesthetically pleasing.

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In addition to medicine, they describe the importance of aesthetics for the design and choice of prostheses. Of course these tools need to function in a particular way, but how they look is not irrelevant. However, the “look” does not have a universal standard. Some people want their prothesis to look as “real” as possible, while others prefer a more robotic look. But these aesthetic options need to be available, so that people have choices.

Beyond these two material examples, Cribb and Pullin also discuss aesthetics in the social dimension of healthcare. The physical environments, including spaces, tools, and medicines, could be well-designed to lead to a welcoming, comfortable, and peaceful experience. But people could easily ruin those feelings without acting in a way that overlaps with those values. Imagine a space feels right at home, but the whole time someone is snapping rude comments at you. That person would undercut the designed space’s aura. To complement the material design, hospital staff need to convey those qualities of comfort, peace, and warmth. This idea has mostly been discussed in terms of bedside manner.

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They go on to discuss that “attention to aesthetics is a way of opening up a consideration of a variety of forms and styles of communication that are underdetermined by ethics.” (6) As different patients prefer different prostheses, so also different styles of communication are effective for different patients. They describe that “this allows for responsiveness to patients and for professionals to modulate, adapt, and expand their approaches (assuming they do so within an authentic and broadly effective repertoire).” (6) Some might think that the style of communication is an unnecessary addition because they just want the facts. While it may appear that “hurried” conversations are more efficient, elegance, they claim, may not require a longer interaction and can also save time and resources. Allowing the professional and patient to set the pace of the interaction encourages clarity and a focus on what matters. And it helps facilitate power-sharing. In other words, aesthetics could actually lead to a more effective system.

To read the full article, click here. But to summarize their argument, they have three parts: (1) Good healthcare should involve a consideration of aesthetics; (2) aesthetic considerations can play a critical explanatory as well as an evaluative role, which can inform approaches to improvement; (3) as QI embraces broader paradigms, aesthetics may prove to be valuable. They end with this statement: “Aesthetics is an everyday matter and talking about it should, we think, become more of an everyday norm in healthcare improvement.” (8)

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