Why are Hospitals Dangerous? The Business of Medicine

The Daily Apple™© Volume 2, Number 4

Wednesday, March 6, 2013 PGY 40 Day #249

The Daily Apple™© Volume 2, Number 4

From Dr. Mike & Infinity Health Solutions

www.ihealsolutions.com  

Why are Hospitals Dangerous? The Business of Medicine

Why are hospitals so dangerous?  Is this a new problem, or worsening of an ongoing problem? How do we fix it?  This is my take on the subject.

During my career, I have watched the Medical Profession fall into a trap driven by The Business of Medicine.  Yes, that's right, it is all about money.  When I started, it was not easy to do the right thing for patients, but we did it.  The Medical Profession, the Art of Medicine and the Doctor-Patient Relationship were important considerations at that time.  Now, for many reasons, dwarfed by the focus on money and business, the Doctor-Patient Relationship has been sold out to the Business of Medicine.  Let's take a brief look at the problem and the fix.

Patient care has never been and will never be perfect, so Quality and Performance Improvement (QIPI) have always a part of what we did to take stock of errors and bad outcomes.  At the start of my career, QIPI generally took the form of Peer Review and Morbidity and Mortality (M+M) reviews.  The traditional reviews of adverse outcomes were strictly medical, mostly confidential and Peer Review has generally been undiscoverable as well.  These processes were not strictly scientific, because they only looked at the cases that surfaced.  Generally they focused on deaths and major adverse events which were perplexing or major errors.  We all learned from these case conferences and, having been actively involved from the start, I learned how to turn the QIPI process into a scientific way of monitoring quality and outcome of care, and how to make care better and best.  So, I have been watching Quality and Outcome in healthcare from the start of my career and I have watched the deterioration over time.  This is what I have seen.

Over time it has become progressively more difficult to focus on the patient first and the Doctor-Patient Relationship.  At this stage, third parties have so much control over the profession, that it is virtually impossible to stand for patients, because the Profession and the Doctor-Patient Relationship have been hijacked by third parties that hold the money.  If a doctor stands up for patients and, in the process slows "the line" down, he or she becomes the identified problem.  The "real problem" gets lost in the shuffle.  Now, the business people drive Doctors to "perform" and that often puts Profit over People.  As the money holders push Patients into "product lines" and Doctors into "line workers", the human factors and rough edges are dismissed, and corners are cut for the sake of "efficiency".  That translates into running patients "through the mill" as fast as possible to "save money". 

Nothing wrong with saving money, right?  But, think about it and look at the facts.  In fact, when we "save money", it does NOT go back to patient care, it goes to third parties who care only about profits and bonuses.  Consequently, the bottom line is this: corners are cut, quality of care goes down, people are hurt and third parties get more money.  That money comes out of the pot that should be used to improve patient care, and goes into the pockets of corporations, share holders, executives, managers and other folks who do not care for or about patients. 

This background sets the stage for deterioration of patient care in hospitals.  As corners are cut and fundamentals are ignored, the most vulnerable of the vulnerable, our patients, become the victims.  Pushing for speed over quality under the guise of efficiency and "cost containment" has interfered with good old fashioned basics of quality patient care.  Generic 'benchmarks" have lowered quality by creating a group think mentality that reinforces bad care as acceptable.  Why? Since we look at hospitals as they compare to each other, standards are lowered to "we are all bad together" levels, instead of reaching up for better and best care.  Hospital QIPI programs are sluggish, disconnected from front line providers, not transparent, dysfunctional at best, and do not come close to the scientific scrutiny required to build the best possible care.

What's the fix?  Objective QIPI and Improve Quality First (IQ First™©).  StepWisely®™©, IQ First™©, Rational Cost Containment™©, Top 10n Targets™© and STOMPPIT™© are each parts of our QIPI Tool Kit™© .  Our Quality Improvement systems are designed to engage Doctors, other care givers, Patients and Families in the processes of improving patient care from the front lines of Patient Care.  When Doctors and Patients unite to drive the QIPI process, we will make hospitals and other health care providers as safe as can be ... we can make each one of them the "best" in the context of the community in which they live.

Join us.  Let us help teach you how to make your hospital stay safe and your local hospital "the best".

Please comment on this blog, or email dr.mike@ihealsolutions.com

Dr. Mike