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Published on: February 16, 2011
Two approaches to improving mental health care: positivist/quantitative versus skill-based/qualitative
1Department of Psychiatry, University of Illinois at Chicago, Mental Health Research, Jesse Brown Veteran Affairs Medical Center, Chicago, IL 60612, USA. daniel.luchins@va.gov
Perspectives in Biology and Medicine
|November 27, 2012
Summary
The current quality improvement model in mental health care, adopted from manufacturing, may be flawed. A balanced approach integrating qualitative methods with quantitative measures is recommended for better clinical outcomes.
Area of Science:
- Health Services Research
- Mental Health Care Quality
- Industrial Engineering Applications
Background:
- The dominant quality improvement (QI) model in healthcare originates from industrial manufacturing, emphasizing quantitative, positivist approaches.
- This model's application in mental health care is questioned due to inherent differences in defining and measuring quality.
- Early 20th-century industrial efforts to quantify manufacturing processes heavily influenced the current QI paradigm.
Purpose of the Study:
- To critically evaluate the suitability of the industrial quality improvement model for mental health care.
- To highlight the limitations of quantitative measures in assessing the value-laden concept of quality in mental health.
- To propose an alternative or complementary approach to enhance mental health care quality.
Main Methods:
- Critical analysis of the assumptions and application of the industrial QI model in mental health.
- Examination of the challenges in operationalizing definitions of quality and clinical outcomes.
- Comparison of quantitative (management-focused) and qualitative (skill-based) approaches to knowing and improvement.
Main Results:
- Operational definitions of quality risk conflating measurement with value.
- Aggregating individual data for benchmarks involves unwarranted mathematical assumptions.
- Clinical outcome selection is problematic, with weak links between process measures and outcomes.
- QI indices changes do not correlate with improved clinical care, offering an illusory sense of control.
Conclusions:
- The industrial QI model's reliance on quantitative metrics may not adequately capture mental health care quality.
- An older, skill-based, qualitative approach utilizing expert knowledge offers valuable contrasts and insights.
- A mixed-methods model balancing quantitative QI with qualitative approaches is recommended for a more holistic improvement strategy.
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