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Declining quality of care: Is the clock ticking?

 Maryam Husain

High profile N.H.S. inquiries into declining care standards and unsafe patient care, highlight many contributing factors including organizational, cultural, staffing and resources, with recommendations for improvement based around addressing these factors. While health care organisations are under pressure to maintain delivery of high quality care, the question of why standards of care continue to decline resulting in failures in modern healthcare settings is key. The focus has turned to gaining a deeper understanding of health care professionals’ behaviors as potential mitigating factors.Health care professionals generally hold strong value in delivering high quality care; however due to factors mentioned previously, these values are compromised, resulting in discomfort (dissonance). Humans are motivated to achieve consistency between values and behavior and discomfort can be reduced by “challenging outside forces”, “reporting discomfort”, and “denial and justification”. When the discomfort is resolved consistency between values and behaviours is achieved. Alternatively when justification, compromise and denial are used to reduce discomfort, substandard care delivery and poor quality ensues. The Cognitive Dissonance Theory by Leon Festinger (1950) provides an understanding of the process of declining levels of care, reiterating the importance of achieving consistency between values and behaviours Conclusion: Substandard care is often the result of efforts to reduce discomfort by ignoring, justifying, and denying, rather than finding practical approaches to restoring good care standards