By: David Kashmer (@DavidKashmer)
Did you know? Our field lags behind many others in terms of attention to basic safety. For those of you who focus on healthcare quality & safety, that’s probably old news. After all, the Institute of Medicine said exactly that in its To Err Is Human report…from 1999 (!)
Here’s a portion of a recent post I wrote up for TheHill.com which describes exactly that & includes a link to that report:
Healthcare is at least a decade behind other high-risk industries in its attention to basic safety.
In 1999, the IOM published “To Err Is Human,” which codified what many quality experts in healthcare already knew: in terms of quality improvement, healthcare is at least a decade behind.
More recently, a widely criticized paper from Johns Hopkins cited medical errors as the third leading cause of death in the United States. Even if you don’t agree that medical errors are the third leading cause, the fact that medical errors even make the list at all is obviously very concerning.
First published in TheHill.com
Click here for entire article: http://thehill.com/blogs/pundits-blog/healthcare/311570-3-facts-about-us-healthcare-that-wont-change-with-the
What you may NOT know is that our field lags when it comes to the adoption of other emerging trends. For example, here’s a graphic from earlier this year:
Now, all of that said, I spend a lot of time wondering exactly why we lag in certain key areas. Here’s what I’ve come up with, and I’m interested in any thoughts or feedback you might have.
(1) Using the word “lag” supposes that the direction everyone else is going is some sort of goal to be achieved or a type of race
It seems to me that the way the graphic above sets things up implies a progression or goal of digitization. In that graphic, it seems as if we are ranked in terms of progress toward some endpoint of digitization. Let’s take some time and consider whether framing the situation as progress toward some digital endpoint really makes sense.
Perhaps no one likes technology more than me. I tend to be an early adopter (and sometimes an innovator) with new devices and software that help me get done what I want to do both personally and for patients. Yes, I use a Fitbit. (Not so special nowadays really.) And I use services like Exist.io to look for meaningful correlations across things I do, such as how much sleep I get with how I perform. This system takes me no time (it all happens under the hood) and sometimes even gives me non-intuitive correlations, which are perhaps the most useful. Here’s an example of what I mean, but this one is weak and I wouldn’t do anything differently based on it:
The bottom line is, I think, every time I see a Big Data article or learn about how websites figure out things about my health that I don’t even know, well, I think we are pretty much all-in on this progression towards the digitization idea…at least I am!
So, on this one, I believe that (yes) there is a meaningful progression toward digitization across industries and, yes, I feel it’s more useful for healthcare to get on board than it is to lament where things are going or to question whether digitization is meaningful for healthcare…and I especially feel good about it when I remember the days of my training and how I used to have to hunt for Xrays on film, yet now I have the Xray or CT scan on my computer instantly!
(2) In part, we are slower to adopt because we deal with people’s health.
We don’t build cars or fly planes, really. Although certain lessons learned from other industries are very important, many in healthcare believe our service is different. Some are even skeptical of whether we should adopt tools that worked well across other industries. We work with people’s health, after all. In the United States especially, that’s a very big deal and many regard it as a true calling. So, being the careful people we are (I often wonder just how risk-averse we are) it seems to make sense to me that our field may be slower than others to adopt new things. It’s very conservative and maybe even highly adaptive to be that way.
When it comes to certain aspects of our work, like patient safety and quality, I should add here that there are well-worn tools that apply to all services–even services like ours called healthcare. We should adopt these, and unfortunately are still behind. I’ll add that adopting these tools helps us as providers even as it helps our patients. (If you’re interested in specifics, take a look at Volume to Value.)
So, bottom line here: part of why healthcare may be slower to adopt emerging trends is because we feel very strongly that only the best, well-worn, known tools should be applied to people’s health.
(3) Sometimes we are slower to adopt because much of the push to adopt has come from outside
About three months ago, I’d just finished speaking at a quality improvement conference in Philadelphia. This one had over a thousand participants from diverse companies. It really ran the gamut from Ford to Crayola to large hospitals to DuPont, and each participant was focused on quantitative quality improvement. After my talk, there were lots of questions. One really struck me in particular:
“How can you improve healthcare quality when you still get paid even when things are bad? I mean, when I make a car if there’s a quality problem and it comes back, I eat that cost…”
This audience member really hit it on the head. Isn’t it difficult to advance topics like quality (where healthcare is a decade behind) if you’re still reimbursed even when there’s a quality issue? What he’d hit on is the tension between a pure fee-for-service model versus value-based reimbursement.
I was able to tell him that healthcare is transitioning, right now, away from being paid even when there’s a quality issue to a model where reimbursement is much more focused on value provided to patients. I also shared with him that things aren’t easy, because we all have to agree on what exactly value and quality means in healthcare, but that we are getting there. We talked about how buy-in from everyone in healthcare for quality initiatives (and more rigorous, quantitative ones), I think, will increase in the next 10-15 years as a result. Sure enough, I think we can see this is already happening:
Our conversation reinforced for me that much of the quality push, and digitization push, has come from outside of healthcare. When the adoption of electronic health records and other forms of digitization are incentivized via meaningful use initiatives, and the HHS department explains that more and more of reimbursement will be tied to value-based metrics, it’s clear that a significant portion of the push to adopt emerging trends has come from outside what may be considered the typical traditional healthcare sphere.
Items that were typically hailed as improvements in healthcare, over the last hundred years, included game-changers like general anesthesia, penicillin, or the ability to safely traverse the one to two inches between the heart and the outside world with cardiac surgery. (Prior to the development of cardiac surgery, some famous surgeons had previously predicted that route would forever be closed!)
Now, especially to physicians, it can be harder to see the value in moving in these directions. Many in healthcare feel they are pushed toward them. Yes, every physician wants the best outcome for the patient, yet seeing quality as the systematic reduction of variation along with improvement in the central tendency of a population is not always, well, intuitive. Given the backdrop of the very specific, individualized physician-patient relationship, it can be challenging to understand the value of a quality initiative that sometimes seems to play to eliminating a defect which the patient in front of the doctor seems to be at low (or even no) risk for.
I’m not saying whether any of this is good or bad, and I’m only sharing what is: we may be slower to adopt these trends in healthcare because they have often come from outside. Rather than commenting on whether this is good or bad, it seems to me that the trend does explain some of why the field is slower to adopt these changes.
Having worked in healthcare for more than a decade through many venues, from cleaning rooms in the Emergency Department to work in the OR as a surgeon, I can share that yes we in healthcare are behind other industries in terms of adopting key trends. However, I believe this is much more understandable given the nature of our work that directly (and individually) affects quality and quantity of human life, as well as the fact that (for better or worse) much of the impetus to adopt these trends has come from the outside. I consider it my responsibility, and all of ours as providers, to be on the lookout for ways in which we can adopt well-worn tools that already exist to improve quality and digitization in our field. Let’s make our call to action one where we get on board with these trends for at least those aspects that we reasonably expect may improve our care.