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"Quality Care is Like a Carton of Eggs"

Canadian woman studies, 2004-10, Vol.24 (1), p.15 [Peer Reviewed Journal]

Copyright Inanna Publications and Education Inc. Fall 2004 ;ISSN: 0713-3235

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  • Title:
    "Quality Care is Like a Carton of Eggs"
  • Author: Guberman, Nancy ; Armstrong, Pat ; Pederson, Ann ; Clow, Barbara ; Jackson, Beth E ; Willson, Kay ; Grant, Karen R ; Boscoe, Madeline
  • Subjects: Biology ; Bisexuals ; Concept formation ; Evaluation ; Gays & lesbians ; Gender ; Health care ; Patients ; Quality ; Racism ; Women
  • Is Part Of: Canadian woman studies, 2004-10, Vol.24 (1), p.15
  • Description: In this paper, we argue that current health care quality assessments lack mechanisms to represent and respond to: 1) important structural features of the health care system (e.g. heterosexism) and 2) women's diverse experiences of care, including what the health system "costs" the women who use it. First, conventional quality assessments examine only limited dimensions of the "structure" of the health care system, conceptualizing structure in terms of the material and human resources, and organizational arrangements of health care settings. This approach fails to recognize and measure important structural relations of power that constitute and shape the health cate experience. Second, health quality assessments are largely concerned with "cost," defined in economic terms. Yet research into women's experiences of health care suggests that a broader conceptualization of "cost" would be useful in understanding health care quality. We discuss these missing elements in health quality assessments, illustrating them with material drawn from focus group discussions with lesbian/bisexual/queer women undertaken as part of a larger investigation of women's understanding of quality of health care in Canada. Our findings suggest that health care researchers, policy makers, workers, and recipients must critically examine what counts as evidence in quality reports and recognize the limitations arising from current conceptualizations and measurement practices. Because current quality assessments rely ultimately on individual-level, decontextualized data, their analysis of quality emerges from simple aggregation of discrete individuals and events. They miss the complex social production of health care structures, processes, and outcomes. Consequently, they do not fully capture women's experiences of health care (as patients, providers, and coordinators of care). Moreover, they envision change as emerging primarily from individual action and local institutional adjustments rather than systemic reorganization. Health-quality assessments informed by a gender-based diversity analysis would produce an explicit systemic analysis to more fully account for what creates quality health care for women. Conventional quality assessments typically measure three elements of health care: structure, process, and outcome (Donabedian; also see Campbell, Roland, and [S. A. Buetow]; Hogston). "Structure" frequently refers to "attributes of the settings in which care occurs"-this could be understood quite broadly to include, for example, social determinants of health such as racism or heterosexism, but universalist quality assessments primarily operationalize "structure" as material resources, human resources, and organizational arrangements. "Process" refers to what is actually done in giving and receiving care. This may include both practitioners' and patients' activities, and may measure both technical aspects of care (i.e., the appropriate and skilful application medical interventions) and interpersonal aspects of care (i.e., humane and compassionate treatment) (Donabedian). "Outcome" refers to the effects of care on the health status of patients and populations. Here, "health" is defined in predominantly biomedical terms, excluding other, non-medical aspects of well-being. Universalist quality assessments typically focus on narrowly defined "structure" and "outcome" measures. [O]nce you're in there, uh, a lot of it are misconceptions about queer or whichever identified women can be very frustrating. It almost feels like it's not worth going in at all... a lot of my friends are transsexuals or gender queer or just relatively open to that kind of thing. And so when [my therapist and I] were discussing incidents that had happened that upset me or I was having trouble dealing with ... she would make me, she' d be like, "okay, so when you say 'he,' that he is actually a woman?" And I' d be like, "No, no, no. That 'he' was born as a woman but is a man. " ... I'm like okay, "So John and I were doing this. " "So you mean John, the girl?" I'm like, "No, John the boy. So him and I did this. " "But you mean she though? That's the she?" And you know, she'd force me to identify the bio, the biology of every single person that I mentioned, and it was just so incredibly frustrating and it just, it got us nowhere because from there on she knew that some of my friends couldn 't fit into her perceptions... And at one point 1 was just like "Okay, I'm sorry. No more. I'm going. Bye. ''Because it was just causing more problems than it was worth.
  • Publisher: Downsview: Inanna Publications and Education Inc
  • Language: English
  • Identifier: ISSN: 0713-3235
  • Source: AUTh Library subscriptions: ProQuest Central
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