"Quality is Love"
Bud Snowden
You may never have heard of Avedis Donabedian. But if you’ve worked in the fields of health care or human services for any length of time, you have been profoundly influenced by his work. Dr. Donabedian is widely regarded to be the father of the “science of quality assurance”---a discipline which transformed health care in the 20th Century and, by extension, the way in which organizations like Volunteers of America care for people with disabilities today.
Born and raised in Lebanon to a Christian family that had fled Turkey to escape the Armenian holocaust, Donabedian studied medicine at the American University in Beirut. He practiced as a pediatrician throughout the Middle East. Then to escape religious persecution and the growing threats of civil unrest and war, he and his wife immigrated to the United States in 1954 to study Public Health at Harvard University.
Dr. Donabedian eventually became an academic, teaching at the School of Public Health at the University of Michigan for 28 years until his death in 2000. Deeply affected by the challenges and limitations of the healthcare systems in which he worked as a young doctor, he dedicated his life to understanding how healthcare systems work and how they can be improved. His contributions to healthcare include addressing issues such as access to health care, completeness and accuracy of medical records, observer bias, patient satisfaction, and cultural preferences in health care.
But it was for his work on measuring and evaluating healthcare quality for which he became best known and which earned him international respect as the “principle architect of the field of quality in health care.” (The International Journal of Quality in Healthcare, 2000.) It was Donabedian who famously introduced the idea of dividing health care measures into “structure, process and outcome.” (If you’ve worked in human services as long as I have, you may remember when discussions about the quality of services came to be framed in terms of outcome measures.)
At Volunteers of America we have taken Dr. Donabedian’s teachings to heart (whether we knew the source of that wisdom or not). We care a great deal about the quality of the care and services we provide to our consumers. We invest a lot of capital, human and financial, in creating processes and building systems to ensure the high quality of our services. We take care to measure that quality through our internal information systems and through external evaluations by independent institutions. And, rightly, we take great pride in the recognition we receive from our peers, funders and accrediting bodies for the quality of our services and programs.
While Dr. Donabedian understood and preached throughout his career the importance of creating service delivery systems that measure and evaluate quality, he also argued that systems, no matter how well designed, in and of themselves are not enough to ensure quality care---they are “enabling mechanisms only.” Late in life, when asked to reflect on the meaning of his work, he concluded, “Ultimately the secret of quality is love. You have to love your patient, you have to love your profession, and you have to love your God. If you have love, you can then work backward to monitor and improve the system."
Dr. Donabedian’s message echoes that of another wise man from the Mideast. To paraphrase St. Paul, though we have the intelligence to design the most sophisticated of all quality care systems, but have not love, our work is for naught. Though we have the faith to move mountains of paperwork, but have not love, we are nothing. Though we work ourselves to exhaustion, sacrificing our health and our relationships, but have not love, it profits us nothing.
If our striving for quality is driven, foremost, by our competitive natures, or our need for public recognition and approval, or even our own sense of accomplishment---rather than by love for our consumers, love for the nobility of the work and love for God--- then our “quality” becomes little more than a “sounding gong and a clanging cymbal.” (St. Paul’s First Letter to the Corinthians, Ch-13.)
So, as we celebrate the accomplishments of the past year and look forward in the coming to year to new challenges and opportunities to improve the quality of our services and programs we do well to remember the message of St. Paul, channeled through Avedis Donabedian, “Ultimately, the secret of quality is love.”
About Bud Snowden
Bud Snowden is the Agency Chaplain for Volunteers of America Greater Baton Rouge and Volunteers of America Greater New Orleans. He has held many different positions in his 31 years with Volunteers of America.