Quality of Care

Systems, regions of the country often lament about workforce shortages in particular sectors of healthcare.  Primary care, nurse practitioners, behavioral health (psychiatrists, psychologists, social workers, counselors, nurses) are considered under-resourced, and under-integrated. But that suggests that if we only had “enough,” everything would be okay. Beneath that veneer of numbers-adequacy lie the questions of quality, improvement, training, standard of practice, and ethics.

Some hypotheticals:  IF:

1. I live in a rural community of 70,000 people and there are very few behavioral health clinicians and those clinicians that are available have been there for a long time and there has been minimal influx of clinicians from outside of this community, how is the quality of care determined and by whom?
2. I live in a metropolitan community of 1,000,000 people and there is an adequate supply of behavioral health clinicians but in response to what is viewed as a reaction to managed care, 40% of the senior behavioral health workforce (primarily psychiatrists and psychologists) does not accept insurance, so in essence, the area is considered a behavioral health shortage area, how is the quality of care determined and by whom?

If professional communities are inbred and the scope of the standard of practice is constricted, quality, versatility, and creativity may become limited. How does the standard of practice improve over time and by what means? What is the ethical obligation of licensed practitioners in any given state? Does board certification guarantee quality? Does continuing education guarantee quality? What is the response of the community? Of training programs? Of the state?

These are some of the issues that go beyond pure workforce numbers that the Annapolis Coalition views as important considerations.