Costs, Healthcare, Healthcare
That's right. Healthcare twice. When talking about efficiency, you must consider cost and two aspects of healthcare--the technical aspect, and the service aspect. The technical part is what CMS is looking at when they ask about conformance to standards of care. Are you treating your diabetic patients according to established professional standards? Did surgical patients receive antibiotics within the two hour window pre-op? These are relevant questions, related to the technical quality of care. But there are two problems: 1. Most people just don't understand or don't care or can't take the time to search for the answers. They go with what their neighbor says. 2. Fudge factors. No provider wants to look bad, so everyone plays the "my patients are sicker than your patients" game. Their statistics are multiplied by a fudge factor prior to publication, and the resulting numbers are all but useless. (The Enron syndrome!) CMS and others are putting forth a major effort to educate patients about what the questions are about and why the answers are important. And there's some evidence this is working. A little bit. But they still fudge the answers.
On the service front, patients do understand this. How easy to make an appointment. How long in the waiting room. Again, some don't care. My neighbor waited 3 hours in a surgeon's office but told me, "That was OK, because he's very good." But some do. My neice left the Northwestern Univ. ER after waiting for 3 hours. A recent study on access in the DC area by some Georgetown Univ. students reported doctors offices were occasionally rude to them on the phone. Rude?? To a customer?? Sometimes it's hard to be polite to a customer who is hostile and comes with a "You owe me ..." attitude. But that's what life is about in a servce industry like healthcare.
Cost, of course is the numerator in the efficiency equation. But both aspects of healthcare must be controlled in the denominator. Robert Samuelson, writing in the Washington Post last Thursday, suggested that most Americans don't really care about cost. We see the costs of our health insurance (at least most see part of these costs), and there are those annoying co-pays and deductibles, but most of us don't see (or pay for) the real costs of our healthcare. For most, health insurance is what pays for healthcare.
None of these factors will become important until Americans have some choice. When health insurance becomes truly "insurance," when health insurance only kicks in when we have spent at least 10% of our income on healthcare, then cost will be important. At that point also, service and technical quality wll also become important. If i'm putting green money on the table, I want an appointment tomorrow, and the receptionist better smile when I walk in! Then, we'll be talking about providing the best value for the lowest cost. Efficiency, of course, is the way to beat your competitors in that game.
Comments
One of the major problems with healthcare today is the fact that it is a price insenstive product. The other major problem is that on both sides of the "counter" the customer and the supplier see poor service as "normal and customary". When talking about healthcare servcie, I always ask if there is anyone in the group that has a pet? Then I ask those persons to compare the way you are treated when you go to your vet to the way you are treated when you go to your primary care doctor's office. There is always a great difference favoring the service at the vet. Why? At the vet, everyone knows that you are the customer and that you pay the bill. In the doctor's office, you are not the customer, you are the patient and the insurer (and therefore the employer) is the one paying the bill. The one to please is the one that pays the bill.
Being the patient, despite all the lofty retoric of how we are becoming more patient-centric, the patient will always be viewed by healthcare staff differently than the staff of a vet's office because you, the patient, don't bring in the money.
It is also the fault of the society that has come to accept being treated with what can only be called total disrepect as a consumer/customer. Where else but in a hospital or a doctor's office does one EXPECT to have to wait long after your appointment time. If the same person had a reservation at a restaurant and then had to wait anywhere from 1 to 3 hours to be seated and then wait even longer to be served, that restaurant would be quickly out of business. Yet in healthcare, we have come to accept it.
The day is coming, however, as more people have to pay out of pocket or out their HSA for care, that patients will look at the cost-benfit of the both the care and the service that they are receiving for their money.
John Harrison, RN, MHSA
Posted by: John Harrison, RN, MHSA | January 30, 2006 11:42 AM
Bingo! The doctor orders the care, the patient receives it, and Medicare pays for it. Where's the incentive to do it well?
Posted by: Robert Burney MD | February 1, 2006 8:10 PM
There is the hitch - no connection between service quality and payment. Until healthcare becomes consumer driven (consumer pays for the service), there can not be any real incentive for good medical care or good service. I belive that HSA's, as they become more prevelent, will begin to increase healthcare consumerism and empower the receiver of health care to determine (probably using various sources of standards for medical care) what is good health care.
Posted by: John Harrison, RN, MHSA | February 2, 2006 10:04 AM
Cost of healthcare delivery may be the numerator in the efficiency equation. However, from a patient's point of view, the cost (of healthcare delivery) is rapdily becoming the denominator in a patient's healthcare "value" equation. The numerator is "outcome quality" plus "service quality."
I thought the article was trying to make this point, but no. Most healthcare organizations have given up on reducing costs. As healthcare outcomes become a commodity via gamesmanship of public reporting and scorecards, increasing the "service quality" part of the numerator in the patient's "value" equation will be the only way to improve healthcare performance or demonstrate the value of services relative to other providers.
Posted by: Barry Johnson | February 7, 2006 2:18 PM
Value, cost, and efficiency are all vital parts of healthcare. None can be overlooked. As I said before they are the pillars of a 3-legged stool.
Healthcare organizations have not given up on improving any of these; but unfortunately, inept managers have looked for the easy out to reducing operating costs, i.e. reducing staff, giving more patients per nurse. This can have a negative impact on the value provided, and once a healthcare organization gets a bad reputation, they can lose millions--especially if the media discovers that harm to a patient was caused by an overstressed employee. System problems (according to Deming) are the responsibility of management; i.e. poor patient care (lack of value) is management's responsibility. However, this is only one leg of the stool. They are also responsible for costs and for the efficiency of the healthcare provider processes. Unfortunately they are also the ones doing the measurements. No wonder they look good on paper.
Posted by: Mattie Groves | February 10, 2006 6:12 PM
Health care is Health care.
The driving force behind health care is no longer care of the patient. A patient is a patient not a customer or a guest or a client.
Press ganey is the tool used by hospitals to serve the patient, how absurd is that?
Nurses are the majority of people used to deliver health care and the least relied upon to evaluate the service.
The empowerment of nurses is long overdue and is the critical tool that will solve the delivery of effecient, thorough and excellent patient care.
Nursing management at the present time is inefficient and useless in empowering the nursing field. These individuals are empowering themselves and deluding the public into thinking that a consorted effort is being made, when infact the exact opposite is true.
We only have to look at one Key point, in our most validated hospitals, (by Press Gainey for example) that the excessively high turnover rate for nurses is something to be majorily concerned about. This fact alone is monumental because it cuts straight to the issue of health care delivery. Why isn't anyone else looking here? This is central to health care.
Posted by: margaret horan | August 18, 2006 8:53 PM
Keep up the great work on your blog. Best wishes WaltDe
Posted by: WaltDe | September 1, 2006 3:18 AM