There is a term we golfers use to describe some of our fellow duffers who spend an inordinate amount of time competing in tournaments: “mug hunters.”These are men (and they are almost always men) who, despite being amateur players, would rather pursue trophies than simply enjoy time on the course with friends. Actually, some mug hunters will do more than compete; they will cheat. I’ve witnessed this behavior first-hand. I know several who have shot higher scores than what was shown on scorecards. It is shocking behavior on a golf course, but it is hardly restricted to that venue. We see people and institutions gaming the system everywhere we look.
Healthcare has a lot of awards programs, some quite professionally done and others, well, not so much. Many organizations enter competitions with a game plan whereby employees will vote to make sure their boss gets recognized on a top 100 list. That is kind of like the old Chicago pol saying, “Vote early and vote often.”
Then there are HCAHPS and Core Measures reports, which are based on a limited number of measures. Hospitals play by the rules, but focus completely on doing well on the scorecards, not on the bigger picture of improving the quality of care they provide across the board.
Not too long ago providers shunned the idea of talking about patients as customers. They said it wasn't very professional, until they realized how bad they looked saying it. Then HCAHPS came along and nowadays providers run advertisements about their concern for their patients and how well patients will be treated if they enter their hospital. That is a positive change, and yet there is a little bit of hypocrisy in it. Hospitals still have a tough time with customer service. Check the average HCAHPS scores nationally if you don’t believe me.
Meanwhile, the dismal reports keep on coming:
- A study conducted by the Leapfrog Group found that one out of every four patients entering a hospital will be harmed one way or another.
- Another study found that 62 percent of hospital physicians discharging a patient were unaware of important clinical findings that had not been addressed, 12.6 percent that required urgent action.
- In a study in the New England Journal of Medicine, researchers led by Dr. Christopher Landrigan, director of the Sleep and Patient Safety Program at Brigham and Women’s Hospital, Boston, found little evidence of improvement in rates of patient harm in North Carolina hospitals during a six-year period.
So the beat seems to go on, with patients as vulnerable today as they were almost 10 years ago when the Institute of Medicine’s Committee on Quality of Health Care in America released its second report on quality care, Crossing the Quality Chasm: A New Health System for the 21st Century. The report spoke to care that is “evidence-based,” “patient-centered” and “transparent.” Some on the committee that drafted the report admit that progress has been slow, but they note that Quality Chasm and an earlier report, To Err is Human: Building a Safer Health System, had changed the mindset of the industry, especially the finding that as many as 98,000 people die each year from medical errors.
Dr. Mark Chassin, who was a member of the committee and is currently president of the Joint Commission, told Modern Healthcare recently that the two IOM reports effectively elevated “the recognition that these problems of overuse, underuse and misuse were quite widespread, and no organization, no matter how well-known, was immune from them. Ten years later, there are few if any leaders who would say, ‘Not in my organization. These are someone else’s problems.' Just a decade ago, it was a drastically different environment.”
Arthur Levin, who also served on the IOM committee and is now the director of the not-for-profit Center for Medical Consumers, isn’t quite so sanguine. He says that our healthcare system has a long way to go before it can truly be called “patient-centered.” One glaring problem, he finds, is that comparative-effectiveness research has lagged far behind where it has to be.
Sam Watson, senior vice president for patient safety and quality at the Michigan Health & Hospital Association and executive director of the MHA Keystone Center for Patient Safety & Quality, states that most physicians and nurses are still educated in silos, which makes it difficult for them to work in a team-based culture. “We need to address the issue that occurs when residents enter their programs and find an old guard of physicians who might not support that team culture.”
Dr. Robert Wachter, professor and chief of the division of hospital medicine at the University of California at San Francisco, concludes: “It's no one's fault. We’re just not very far along in the science of measuring quality for complex, real-world patients whose conditions have a lot of overlap. We’ve made baby steps.”
Most committee members feel that in the next 10 years, significant progress will be made in the quality of care delivered to patients. That remains to be seen.
We live in the United States of America, where change is coming at us at an unbelievable speed. Progress in healthcare, by contrast, is almost too slow to be measured. The American people deserve better, especially since this country currently spends about 19 percent of GDP on healthcare. Shouldn't we be getting a bigger bang for our buck? Shouldn’t we be treated as insiders, not outsiders, in decisions that will affect our future quality of life?