Healthcare Efficiency

Yes, Virginia, there is a Santa Clause.  And yes, Shannon, you can find good healthcare.  But I want Xmas every day.  Why should healthcare be an adventure where you never know what's going to happen.  Healthcare should not be like opening presents--it should be predictable.  The first rule of quality is consistency.  Artemis March lists consistency as one of the three 'C's of Seamless Patient Care.  Doing well is not a mystery!  The NQF has published standards.  A few healthcare institutions have won Baldrige Awards.  Ask in a comment, and I'll send you my paper on doing things well in ambulatory surgery.  So, why doesn't it happen every time?  What does it take?  One key ingredient is the Hallmark principle:  You have to "care enough to do your very best."  Creating that culture in an organization requires leadership.  The profit motive helps, but it's not essential.  Interestingly, if you focus on profits, you'll likely miss everything else.  Aim for the bullseye, and you'll miss the target.  However, concentrate on providing excellent healthcare service, and you'll make money.  Unfortunately, this is not as true in healthcare as in other industries, partly because of misplaced competition.  But more on that another time.

Posted by Dr. Robert Burney at 09:12 PM | Permalink | Comments (2)

I’m an expert now!  Been there, done that.  Recovering from ambulatory surgery at the hospital (H) most would consider the best in the DC area.  The good news is that I survived!  They didn’t make a fatal error in my care.   On the other side, there were some customer service (CS) goofs, some quality of care (QC) issues, and some inefficiencies (E). I called to pre-register by phone.  Three times.   CS goof #1!  The person who finally answered didn’t speak English well.  CS goof #2:  The public face of your institution--the clerk who registers surgery patients, can’t spell “inguinal hernia.”  She also didn’t tell me when to arrive or where to go.    I did find the “patient registration” desk where a clerk instructed me to wait for a second clerk who then collected all the information I had given over the phone two days ago.  Sounds like two E problems.
  “Go up to the  second floor.  If there’s no volunteer at the desk, find a nurse on 2 West.”  This hits at least E and CS.  If the volunteer is an integral part of the process, MAKE SURE THERE IS ONE!  If not, put her to work somewhere else.  I soon lost track of the number of people who came to see me.  (E)  One person could have done it all in about 5 minutes.  One of these was the OR nurse.  E.  I realize this is a relevance issue for them, but she belongs in the OR.  Let someone else get the patient ready.   The PA repeated what my MD had done the week before, and not as well. E and QC.
In the OR, the anesthesiologist who was supposed to be taking care of me was off chinning with the nurses and oblivious to the fact that the local anesthetic was not quite adequate.  (QC) The OR nurse asked the surgeon if he wanted antibiotics, and he said, “no.”  Whoa!! That’s a NQF standard.  Why is he allowed to say no?  Another QC.  Post op, no one asked me if I had pain (I did).  The JCAHO requires this. QC.  Of course, no one asked me if I wanted anything for pain (I did, but didn’t get it.)  
When I left, they didn’t give me a survey or ask me if things went well.  I guess they don’t care, and that would explain all the other items.  
WHY does this happen!  OK, these are small issues.  No one died.  But they are the canary in the coal mine.  The E problems could be solved by reducing payments.  AHRQ thinks that the other issues would improve by informing patients and giving them more choice.  But I chose this place!  The have good marks from HHS.  Are there no places to get good healthcare in the US?  Forget excellence--just satisfactory.

Posted by Dr. Robert Burney at 07:07 PM | Permalink | Comments (5)

Almost every article on healthcare mentions cost, and every politician talks about costs.  We do pay more per capita for healthcare, and the short answer is that prices are too high.  We don’t see the doctor more often--the Germans get the prize for that.  We have fewer hospital beds and other resources than many countries.  Malpractice is a disgrace, but still less than 1% of HC spending.  Our population is aging, but not faster than others.  It just costs more here.  Drugs are more expensive, surgery costs more, and a visit to the doctor will set you back more in the US.  Why?  Cost of living accounts for some of this, but mostly, there is no downward pressure on price.  No purchaser is price sensative.  Patients shop for cheap airplane tickets but not for cheap appendectomies.  Besides, patients don’t pay for healthcare.  Insurance companies decide internally how much they will pay, and generally that’s what everyone gets.  They don’t get bids.  I once offered an HMO a 40% discount on their ambulatory surgery and they said no.  It’s actually against the law to offer discounts to Medicare patients.  Porter and Telsberg argue that competition is occurring at the wrong level and is a zero-sum game.   Competition in HC is seen “at the level of health plans, networks, and hospital groups”.  To have any effect on cost, it should occur for individual diseases or patients or operations.  If a US hospital offered a 10% discount on hip replacements, Medicare would put them in jail but no one else would take notice.  Those who don’t have insurance and are price sensative can find bargains overseas.  In the present US situation, the focus is on reducing costs to increase profits rather than on providing greater value to gain market share.  

Posted by Dr. Robert Burney at 09:00 PM | Permalink | Comments (4)