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How do I make my choices with the best chances of getting the highest quality care?

What would you say if I told you that there was a country:

Where somewhere between 48,000 and 440,000 people died each year due to preventable medical error.  Numbers vary in studies from the Institute of Medicinethe BMJ, and the Journal of Patient Safety as reported in Healthcare IT News.  This makes preventable medical error the third leading cause of death in this country.

Where 33% of all inpatients are subjects of adverse events or medical errors of some type (not necessarily fatal).

Where many hospitals continue to fail the standards set by The Leapfrog Group for preventing ‘never events’.

Where there is a small but growing group of physicians who are making courageous moves to institute quality measures to address these problems, but that these efforts are often unwelcomed and have cost many their careers.

Where several of this group of physicians often speak at conventions and continuing medical education venues, and when they ask audiences of physicians “who here knows a physician who should not be practicing medicine”, they often see every single physician in the audience raise their hands.

Where some of these same physicians have collaborated in creating a Patient Safety Culture Survey to be anonymously responded to by physicians, nurses, technicians of all departments (cardio, OB, ortho, etc) in hospitals. Over 600 hospitals participated. One of the questions on the survey is “Would you want one of your family members to be treated in your unit?” 50% of respondents indicated no.

Where residents (doctors in training) are routinely working under extreme sleep deprivation, predictably increasing the risk to patients.

Where there is a culture of omerta amongst providers in this country; bad outcomes are not spoken of openly. Root cause analysis is not necessarily done in any methodical way. The hospitals who participated in the survey above did so on the condition of complete secrecy. There are many, many cases where physicians and other medical staff have spoken out about inept colleagues or dangerous processes, or who recommended other positive changes to facilitate quality, only to be censured, ostracized, or even fired.

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“Knowing is not enough.  We must apply.  

Willing is not enough.  We must do.”

Goethe

As quoted on an introduction page to The Healthcare Imperative; Lowering Costs and Improving Outcomes

by the Institute of Medicine

With the exception of the first two points above, little of the information above had been public knowledge until brave insiders began lifting the kimono.  We all thank you, Dr. Marty Makary for Unaccountable and Dr. Eric Topol for The Creative Destruction of Medicine and The Patient Will See You Now.  Please keep doing what you’re doing!

The problem isn’t that we collectively don’t know how to improve quality and lower costs;  the problem is that the existing players in The Old Game are exceptionally resistant to change.  And they are making a TON of money.  Despite hospitals, state medical boards and medical associations knowing all of the above, little meaningful progress towards improving quality or outcomes has been made since the first statistics became available in 1998. We continue to lose roughly the same number of people each year due to preventable medical error.

By now, you’ve probably guessed what country I’m talking about.

 

We, as Americans, suck at healthcare

Despite having worked in this industry for over 25 years, even I was astounded to learn some of this information. By and large, the individual doctors, nurses, and technicians providing our care are dedicated professionals. But in some cases they are not. And more often, they work in an environment that is not engineered for culture, process, teamwork, or optimal patient outcomes.

A common paradigm for most quality systems is errors or unexpected (undesired) outcomes per number of transactions. Companies like Amazon and FedEx might have 1 error or unexpected outcome in 1,000,000+ transactions and if we’re the one customer in over a million that suffers the consequences of that error, we are furious! In healthcare, we’re experiencing 1 error in every 3 or 4 encounters. But chances are, until now you didn’t know that.  Why?  Because the Quality of Life Serpent is very, very sneaky.  And very good at his job, which includes hiding this information from public view.

The bottom line is that we cannot simply drift into our current sick care delivery model and presume we’ll get high quality care. It’s a crap shoot.

 

What can we do to improve the odds for ourselves and for our families?

The answer is both simple and complex.   The first step is to be very deliberate in choosing your primary care provider, so that your confidence and trust level is very high. Then, when you need specialty, surgical or other procedural care (such as for a colonoscopy), ask your primary care provider ‘where would you send your brother/sister/mother/ father/child if they needed this care?’ or ‘Where would you go?’ Notice that this is asking them for a personal recommendation. If you ask ‘where should I go?’, you’re asking them for a professional recommendation. They may feel obliged, for example, to refer you to the hospital where they have privileges, as opposed to sending you across town to another hospital they’re not affiliated with but where they know you can get superior care.

 

The most reliable information about where to go for the best quality care comes from those inside the provider club

Your Primary Care Provider probably won’t know every detail about every hospital and every other specialty they may need to refer you to, but they’re still the best place to start. If they can’t come up with a solid, supportable reference, then the next best place to go is to find a physician, nurse, or technician who actually works in the specialty you need, or in the specific department within the hospital you’re considering using. If nothing else, go onto FaceBook or LinkedIn and see if you can network a lead.

Bear in mind during your search that the so called Quality Reporting done in public media, such as ‘Best of …’ lists, is worse than useless since the criteria for data collection is questionable at best. Some rankings are available to anyone willing to write a big enough check. Even the best intended and most independent ‘best of’ lists are highly subjective. For a great explanation of this phenomenon, see Malcolm Gladwell’s article The Order of Things in the New Yorker.

Remember:  We coach, support, educate, and empower.  We illuminate options you may not have known you had.  But we don't decide what's right for you in your unique circumstances; only you can do that.  And we don't provide medical, financial, or legal advice; nor do we replace the valuable counsel of those who do.