How do you measure quality in healthcare?

Original post:  Mar. 20, 2012

A recent opinion piece in the New York Times was quite thought provoking. An oncology nurse,Theresa Brown, wrote "Hospitals Aren't Hotels" to discuss the challenges in placing quality measures on healthcare facilities.

"The nurse opens with a discussion of a painful procedure to keep fluid from building up in the tissue around the patient's lungs.

The pain of the initial procedure is absolutely necessary in order to ward off an even greater (and more painful) future health threat.

She then wonders about the "patient satisfaction" score that would be associated with that particular patient's experience in the hospital."

With the increased emphasis on how the "consumer" perceives their treatment, she reminds us:

The problem with this metric is that a lot of hospital care is, like pleurodesis, invasive, painful and even dehumanizing. Surgery leaves incisional pain as well as internal hurts from the removal of a gallbladder or tumor, or the repair of a broken bone. Chemotherapy weakens the immune system. We might like to say it shouldn’t be, but physical pain, and its concomitant emotional suffering, tend to be inseparable from standard care.

She points to a study that higher satisfaction scores were linked to increased consumption of services and, ironically, increased mortality.

"In other words, evaluating hospital care in terms of its ability to offer positive experiences could easily put pressure on the system

to do things it can’t, at the expense of what it should.

To evaluate the patient experience in a way that can be meaningfully translated to the public, we need to ask deeper questions,

about whether our procedures accomplished what they were supposed to and whether patients did get better despite the suffering

imposed by our care."

It's a very difficult question. Our future strategies will depend greatly on how that question is ultimately answered.

Old school thinking

Original post:  September 30, 2011

The term "old school" is often applied (derisively) to methods that are now obsolete.

I met yesterday in a planning meeting for a major supply chain conference. There were a number of high powered staff from across the healthcare supply chain. With the rising spectre of health reform looming in the shadows, there is a lot of fear and uncertainty about the coming future. Many hospitals are struggling to stay profitable. This has put increased focus on the supply chain as a pathway to the savings and efficiency gains these hospitals are desperately seeking.

One of the hospital vice presidents talked about the dynamic in his hospital network. His direct boss is the VP of Supply Chain. He represents the "old school" mentality. In that mindset, the device manufacturers are seen as an enemy that must be beaten at all costs. He doesn't understand why his team can't simply pull the suppliers in a room and demand a 10% price decrease! Fortunately, his CFO is higher in the hierarchy. He understands that there is a need to find new ways to work with suppliers to achieve the desired results.

This particular VP has begun to approach his key suppliers and ask them how he can help reduce overall costs for both sides. One innovation that they came up with was a switch from daily daytime deliveries to fewer nighttime deliveries. By receiving his product in a consolidated manner during a slack period for the manufacturer, he made it much easier for both sides by reducing the overall cost to manage the goods. He is also able to maintain a solid working relationship with a key supplier who is highly valued by the clinical staff. That avoids unnecessary disruptions caused by abrupt switches to unfamiliar suppliers.

As this particular executive stated:

"If you focus on quality, you can help reduce costs.

If you focus on cost, you often increase costs and reduce quality."