When I moved from the news business, writing about crime and investigating corrupt politicians and police officers, to the healthcare industry in the mid-1970s, we measured only the basic hospital performance indicators — including census, staffing, inventory, days in accounts receivable and average length of stay. The data was not in real time by any stretch of the imagination. By the time the information was produced and distributed to managers, the horse was already out of the barn and in the next county.
Today, we measure almost everything. The question is: are we getting any better in terms of quality and safety? Are we now paying too much attention to the numbers and not enough to the people?
We are certainly better at collecting and producing data in a timely manner. Financially, most hospitals are better. But what about the quality and safety issues? Are our patients safer? Do they receive better care?
It is not like we don’t have a multiple of compelling reasons, including financial survival. Sure, implementing medical billing software has definitely helped in data consolidation and improved billing methods, leading to quicker reimbursements and thus, better patient experience (in terms of finance). But what about the rest of the experience? Quality, safety, and patient satisfaction will drive future levels of reimbursement from the government and commercial payors. It is imperative that we get on top of this problem once and for all.
Before we start talking about the costs of achieving success, we should remember that it all revolves around people and process. As an industry we have spent hundreds of millions of dollars trying to address quality and safety issues and we are still not even close to where we need to be. Maybe it is time to try a new approach. This does not just apply to patient safety, but also to the safety of staff around the hospital that cares for the patients. Everyone in these buildings needs to feel secure about who is in there and their role, implementing specific ID badges from companies like InstantCard, can help keep that level of safety for patients and the security of the building, stopping anyone wondering in, or being somewhere they shouldn’t be. Patients go into hospitals to be treated, they must be assured their safety.
A leading chemical industry safety expert who consulted with several hospitals on quality and safety said she was stunned to see how little transparency there was in the hospital quality improvement process. After the attorneys and risk managers charged into the breach, scrubbed the scene and admonished the participants, there was very little honest discussion about what went wrong and how it could be fixed so the events did not happen again. Her overarching theme is startlingly simple: what we have been doing is not working and the outcomes will not change unless we rethink our entire quality improvement approach, sans the lawyers and risk managers. It is not that difficult, she said. Do what other industries are doing.
Proctor & Gamble Chairman and CEO Bob McDonald emphasized in a recent speech that innovation was the way of the future. Only 10 of America’s Fortune 50 companies in 1955 are still in business today. The rest failed to innovate, he said. Hospital leaders, especially those who feel invincible, should take note. The speed of change is moving at a significantly faster pace today, especially in healthcare, and the demise of organizations will come much sooner.
If we cannot innovate to solve our troubling quality, safety and cost challenges, who will be around in 10 years? What can we do now that successfully changes our current performance trajectory and inevitable failure rate?
Maybe we should start by making it mandatory for every nurse, doctor, pharmacist, patient care aide, and housekeeper to think of each patient as a member of their family, someone they love and want to protect — a new hospital Golden Rule. The other obstacles to quality and safety that we have created – complexity, cost, alignment – are just excuses for not trying to innovate. Often, doing the simple stuff is the better way to care for our patients.
Maybe it is all about people, process, and a willingness to innovate.
2011 John Gregory Self