Tuesday, January 25, 2005

Childish Behavior in Health Care

This morning’s Boston Globe had a front-page article by health reporter Scott Allen about how Eliot Hospital in Manchester, N.H. had improved its obstetrical services by applying something called Flow Management.

As I understand it, Flow Management is what the parking garage near the Huntington Theater in Boston does when it asks me to pay when I park so as to avoid the long line at the cashier’s window when the play is over.

It doesn’t sound very complicated but seems to be the latest rage in health care. The heads of no less than Harvard Pilgrim Health Care, the Institute for Healthcare Improvement and the Cambridge Health Alliance were quoted commenting on its marvels.

According to the report, what Eliot Hospital did was to divide its obstetrical beds into two groups, reserving one for scheduled induced deliveries and the other for normal deliveries. Nothing very striking about that. But the article went on to point out that previously, most of the obstetricians scheduled their induced delivery patients for 7:00 a.m., thus simplifying their own schedules for the rest of the day. Then whenever there was a surge of normal deliveries, inductions had to be cancelled, causing confusion and unhappiness all around. Limiting the number of beds available for inductions forced obstetricians to schedule their inductions at various times throughout the day, thereby evening out the “flow” of patients.

Why, one might ask, had not someone thought of that long ago? If a parking garage could figure it out, why couldn’t hospitals? Eugene Litvak, Flow Management guru on the Boston University faculty, suggested an answer. “….for clinicians, particularly physicians” he said “there is an element of disrespect toward managers.” As a result they “view aggressive managers as a threat to their traditional autonomy.”

After reading the article, wife Marilyn said she didn’t know whether to laugh or cry – to be happy because service was improved or disgusted because grown-ups engaged in the important business of caring for patients could behave so childishly.

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