28
November
2006
So I have been studying for my Certified Healthcare Executive accreditation for the past few months (hence the low number of posts) and it has gotten me thinking about what it means to be a competent healthcare administrator again. This has come up as I have seen a number of reports on recommended quality practices. For instance, an article in the NEJM sponsored by the National Heart, Lung, and Blood Institute, recommended a series of practices to reduce door to balloon time for myocardial infarction patients. What struck me about the list was a number of the recommendations weren’t just for clinical folks. Plain old healthcare administrators, in the right role, could implement some of these practices and presumably impact a healthcare outcome.
This isn’t really earth shattering on its surface. As healthcare administrators, we talk about improving quality all the time, but most of that talk is around structural or process issues that speak to the cost, availability, or effectiveness of services. We certainly care about patient outcomes, but those measures have been “owned” traditionally by the medical and nursing staff. They were the ones with the training and tools (I would argue that their perspective plays a key role as well) to evaluate the outcomes of clinical care. That certainly hasn’t changed and healthcare administrators will always depend on our clinical counter-parts for this.
I think what has changed is the expansion of what is being considered to impact patient outcomes. More and more we are looking at process measures, not just for efficiency sake, but for their impact on the patient. An example is wait times in the ED. We are also looking at aspects of the hospital environment that impact not only patient satisfaction, but health outcomes as well. An example is natural lighting in the patient room.
I have always said that every decision impacts the patient in a hospital, but it is becoming more clear, to me at least, that healthcare administrators impact patient outcomes. What does that mean for us as professionals? Can bad management kill patients? Perhaps. All the more reason I need to pass my test.
Posted: Leading Healthcare, Healthcare Quality
25
October
2006
It has been a while since I have written a real post…so where shall I begin? How about with a clean bed, where most patients hope to start their hospital experience. Unfortunately, it appears that a clean bed isn’t always what it seems. A recent article in the Archives of Internal Medicine reported that ICU patients in beds that were previously occupied with MRSA infected patients had a 40% higher chance of catching the bug than patients whose beds had not. The collective cry of “eh!” from everyone reading this statistic is definitely ringing in the ears hospital housekeeping managers across the country.
Let’s take a look at the typical housekeeping department of an American hospital. For one, it is staffed by some of the lowest paid employees in the hospital, which, of course, is not a reflection of their value to the organization, but more of the market. As it is an overhead department, it is likely staffed to the bare bones as well. Frequently, this owes to the fact that housekeeping departments usually report up to a general services VP, who often reports directly to the CFO. The housekeeper is a relatively isolated member of the patient care staff. They are usually assigned a zone or group of departments to work in alone and are not considered a member of those departments’ patient care teams. On top of all of this, there is a significant pressure from nursing to “turn over” beds quickly - that is to clean them after a patient has been discharged to get it ready for the next patient. It is in this context that the housekeeper preforms his or her most important task - keeping a bug from one patient from passing to another.
My hope is that this study will cause hospitals to take a second look at not only their infection control policies, but the larger issue of how housekeeping is integrated into the patient care process. If the hospital is supposed to be a special place where the sick go to get well, then we need to make sure that manage each step of the process to that end. Even the clean up.
Posted: Healthcare Quality
10
August
2006
Diagnostic Uncertainty. The phrase actually sends shivers down my spine. It is the big “I don’t know” of medicine. If there is uncertainty in the diagnostic process, then you can’t move on, you are stuck with the questions and the anxiety and the thing inside of you causing symptoms that could be a sign of anything. And, yet, diagnostic uncertainty can be a good thing too. It can be the yellow light that causes us to slow down and look both ways – to look for other symptoms and other diagnoses. Waiting a little longer for the answer, conducting that one extra test, just might be the right thing to do.
Healthcare providers should keep this lesson in mind, as well. Indeed, that was the finding of a group of researchers studying the treatment of pneumonia (see their article in the journal CHEST). It is generally agreed that pneumonia patients should be given antibiotic treatment within 4 hours of being seen at the hospital. In fact, hospitals are “graded” on their performance in this area and strive for 100% compliance with the practice. But here is where the diagnostic uncertainty comes in. The researchers found that there were some patients didn’t quite present as classic cases of pneumonia and the right thing to do in those cases is to delay treatment, even if it pushes the treatment past the 4 hour mark. Now my point here isn’t to discuss the validity of the study (the sample did seem a bit small) or the best practice, it is to remind healthcare providers (administrators mainly) that we can’t solely depend on best practice to guide medical decision-making. Even though healthcare is a business, medicine is a science, so they won’t always be in agreement over the right thing to do.
This is the second study that I have written about to question some of the best practices that hospitals are being asked to adopt. With the increased (and appropriate) focus on these practices, they are not likely to be the last. In the end, the industry is doing the right things – clinical guidelines, quality scorecards, pay for performance – and hopefully medical research will continue to inform it.
Posted: Healthcare Quality
