Thursday, September 16, 2004
Physicians – Hospital Staff Members or Customers?
In commenting on its annual list of the 100 “Most Wired” hospitals, the journal H&HN (Hospitals and Health Networks, July, 2004) pointed out that in the most wired hospitals, “nearly 27% of medication orders are electronically entered by physicians.”
That caused me to wonder whether the airlines, when they went to computer-printed baggage tags, kept records on the percentage of their baggage checkers who used them instead of filling out the old ones by hand.
Not a fair comparison, you might object. A better one would be with the percentage of passengers who make their own reservations electronically and print their own boarding passes. No doubt that is a number the airlines watch very closely.
The difference of course, is that baggage checkers are staff members and passengers are customers.
In which category are the physicians who do and don’t enter their medication orders electronically? Are they staff members or customers?
The malpractice courts that regularly assess judgments upon hospitals for the mistakes of physicians and the various quality measurement agencies that rate hospitals act as though they are staff members. If they are right, then there is no excuse for anything much less than 100% compliance on entering medication orders electronically.
But H&HN (and, most likely, the typical hospital) acts as though they are customers who must somehow be enticed into entering their orders.
Uncertainty about whether the most important decision makers in hospitals are staff members or customers is a major barrier to meaningful redesign of our health care system.
It also goes far to explain why the dealing with the cost and quality problems in health care has proved so difficult.
In commenting on its annual list of the 100 “Most Wired” hospitals, the journal H&HN (Hospitals and Health Networks, July, 2004) pointed out that in the most wired hospitals, “nearly 27% of medication orders are electronically entered by physicians.”
That caused me to wonder whether the airlines, when they went to computer-printed baggage tags, kept records on the percentage of their baggage checkers who used them instead of filling out the old ones by hand.
Not a fair comparison, you might object. A better one would be with the percentage of passengers who make their own reservations electronically and print their own boarding passes. No doubt that is a number the airlines watch very closely.
The difference of course, is that baggage checkers are staff members and passengers are customers.
In which category are the physicians who do and don’t enter their medication orders electronically? Are they staff members or customers?
The malpractice courts that regularly assess judgments upon hospitals for the mistakes of physicians and the various quality measurement agencies that rate hospitals act as though they are staff members. If they are right, then there is no excuse for anything much less than 100% compliance on entering medication orders electronically.
But H&HN (and, most likely, the typical hospital) acts as though they are customers who must somehow be enticed into entering their orders.
Uncertainty about whether the most important decision makers in hospitals are staff members or customers is a major barrier to meaningful redesign of our health care system.
It also goes far to explain why the dealing with the cost and quality problems in health care has proved so difficult.
