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Twenty years since the U.S. Institute of Medicine defined quality in healthcare, Peter Lachman and colleagues now propose a new, “kin-centered” model of care with equity and kindness at its core. Here, Dr. Lachman, a leader in quality improvement and patient safety, shares how the model came to be and the cultural shift needed to put it into action. 

In 2005, I was fortunate enough to go to the Institute of Healthcare Improvement (IHI) in Boston as a Health Foundation Fellow. It was here that I was exposed to the leading thinkers in quality improvement (QI) and patient safety. At the time, the QI movement was just beginning, and the U.S. Institute of Medicine (IOM) model of quality in healthcare was only a few years old.

In our Opinion Article, my colleagues and I aim to redefine quality with the advantage of the experience gained over 20 years. We chose to publish on F1000Research because we wanted immediate publication, with the opportunity for transparency, which is one of the core values of our model. Having the reviews and comments on the platform alongside the paper adds to the richness of the debate. I believe that openness will add value.

Limitations of the IOM model

Groundbreaking at the time, the IOM model provided the catalyst for the current focus on quality in healthcare, emphasizing safety and quality of health care services. However, the model has failed to deliver significant results in practice. Some inherent limitations of the model include:

• The concept of patient-centered care has the person we call a patient in the role of being a patient, with the inherent challenges of power differentials. The idea of person-centered care followed the IOM model. The model did not explicitly include the providers of care.
• Although the core values of our new model are present in the IOM model, they are not as central. Integrated care was not a major topic, and neither was coproduction (having only come to prominence more recently). 
• The IOM model did not consider climate change to be a core domain of quality.

Redefining what it takes to make a difference

Over the past twenty years, the concept of quality has evolved from managing healthcare delivery (i.e., disease management to be less harmful, more efficient, and less costly) to the management of health. Health goes beyond the person we call a patient. Rather, it also involves the family and the wider kin or community. Our framework is about sharing power with the people receiving care and developing a partnership focused on health even when managing disease.

Core values of the new model

Firstly, we liked the word “kin” because it relates to the concept of kindness which is a core value of the model. Kris Vanhaecht, one of my co-authors, has been introducing small acts of kindness into day-to-day activities called Mangomoments. We believe that these acts benefit people receiving and delivering care and can go a long way to dealing with alienation with healthcare and burnout. Furthermore, we also ensured that transparency surrounds every domain of our new model. We believe that the future healthcare and health model needs to be open to all. Finally, Paul Batalden, another co-author, has been working on coproduction, and we saw the synergy converging in the paper.

Transferring power from the providers to the people

We think that quality improvement is moving through three phases – all are essential, but one graduates from one phase to the next.

• The first approach we call Quality 1.0, which is more about assurance. This phase is where the regulators and accreditors live.
• Over the past 25 years, we have had Quality 2.0, which is trying to fix the defects in the system—for example, using methods such as Lean and Six Sigma.
• We now need to move to the next iteration, Quality 3.0, where we recognize that the person and the kin own health and coproduce health with them. This iteration requires a transfer of power from healthcare providers to the people.

An opportunity for change

The model is about a transfer of power that will require a culture shift. I am confident this will happen, as many different movements are currently underway. The emphasis on kindness is growing. There is more literature on the integration of care and coproduction. There are many more examples of the need to think differently.

The COVID-19 pandemic has demonstrated a vulnerability in healthcare, both in the workers and the general population. The education we give clinicians needs to change, as it is very technical, and people need more than that. It is an opportunity for us to think very differently, and this new model is the first step.

Putting the new model into practice

Our model serves as the foundation for each organization to build its own vision of quality. Organizations can use a new co-creation model with drivers, building blocks, and action fields to integrate their vision into the daily management of the organization. We are fortunate that the model has been adopted in Flanders, Belgium, where Kris is based. They now have 19 test sites (16 general hospitals, two rehab centers, and one mental health organization). This new quality management model in Flanders is called FlaQuM – the Flanders Quality Model.

We will be presenting the model at the BMJ International Forum in Gothenburg in June 2022, which we believe will provide impetus to its spread.

Looking forward

Subsequent research will assess how organizations can implement the model and whether it can make a difference. The results from Flanders will be interesting as it is a region already moving in this direction. We are looking for more organizations to adopt this new way of thinking. Interestingly, patient surveys showed that they agreed with all the dimensions. However, they did not see climate change as one to consider. As a result, we need to conduct more work in this area. 

Read the full Opinion Article on F1000Research today to learn more about this new multidimensional quality model in healthcare.