Friday, May 20, 2005
Rethinking Lay Interference
The April, 2005 issue of H&HN, the monthly journal of the American Hospital Association, featured an article titled 25 Things You Can Do to Save Lives Now.
As the title implies, the “things” listed tended to be of the common-sense variety, like washing hands and marking surgical sites accurately.
What struck me, however, was how many of them would have been seen not so long ago as interference in the practice of medicine. One had to do with handling risky medications. It reminded me that early in my career I learned that our outpatient pharmacy each day assigned a pharmacist full-time to the duty of clarifying prescriptions that were either erroneous or unclear. I thought we should perhaps do something about that but was quickly made aware that prescribing drugs was doctor business and I should stay out of it.
That seems to be changing. The introduction to the H&HN article notes that “hospital leaders worry about creating too many restrictions in clinical practice.” In response, Dr. Don Berwick, leading guru of quality in health care, is quoted as saying “That concern is misaligned because clinicians are looking to hospital executives and the board for direction.”
If by “hospital leaders” he means CEO's, most of them won’t be so sure about that. But Berwick’s willingness to say it publicly suggests that the epithet “lay interference” may be losing its punch. If so, progressive hospital leaders can be more assertive in promoting improvements in patient care by causing clinical practice standards to be laid down and enforced.
That would sure enough be a redesign of the system.
The April, 2005 issue of H&HN, the monthly journal of the American Hospital Association, featured an article titled 25 Things You Can Do to Save Lives Now.
As the title implies, the “things” listed tended to be of the common-sense variety, like washing hands and marking surgical sites accurately.
What struck me, however, was how many of them would have been seen not so long ago as interference in the practice of medicine. One had to do with handling risky medications. It reminded me that early in my career I learned that our outpatient pharmacy each day assigned a pharmacist full-time to the duty of clarifying prescriptions that were either erroneous or unclear. I thought we should perhaps do something about that but was quickly made aware that prescribing drugs was doctor business and I should stay out of it.
That seems to be changing. The introduction to the H&HN article notes that “hospital leaders worry about creating too many restrictions in clinical practice.” In response, Dr. Don Berwick, leading guru of quality in health care, is quoted as saying “That concern is misaligned because clinicians are looking to hospital executives and the board for direction.”
If by “hospital leaders” he means CEO's, most of them won’t be so sure about that. But Berwick’s willingness to say it publicly suggests that the epithet “lay interference” may be losing its punch. If so, progressive hospital leaders can be more assertive in promoting improvements in patient care by causing clinical practice standards to be laid down and enforced.
That would sure enough be a redesign of the system.
