Friday, September 29, 2006

Nice Try but No Cigar

In response to the Boston Globe article about the hazards associated with overworked nurses and house officers (the subject of my posting titled It’s a Puzzlement), the Massachusetts Hospital Association (MHA) wrote a letter to the editor that appeared on September 28, 2006.

The letter talked about how MHA had promoted research on this subject and held annual workforce summits to share findings. It referred to a statewide program called Patients First sponsored by hospital and nurse leaders that includes the “unusual commitment to end mandatory overtime.” It mentioned MHA efforts to expand the work force by encouraging the development of education programs. It affirmed its support of the Patient Safety Act – proposed legislation that would “improve the supply of nurses…, measure the quality of nursing care…., and allow hospitals to voluntarily set limits on the hours staff can work.”

Since when do hospitals need legislative permission to “voluntarily set limits on the hours staff can work?”

MHA no doubt submitted this letter in an attempt to position itself on the right side of the issue.

To which my response is – nice try, but no cigar.

Wednesday, September 27, 2006

It’s a Puzzlement

I continue to be puzzled by the apparent reluctance to hold hospitals accountable for what they do and don’t do.

Nurse/author Suzanne Gordon had an op-ed column in the September 22, 2006 issue of The Boston Globe. Its basic theme was that nurses and house officers who work too many hours are more prone to make mistakes. She quoted a Harvard study of the subject to support her point.

She concluded by saying “Until there is the public accountability that federal regulation provides, patients – as well as doctors and nurses – will continue to pay with their health and even their lives.”

Don’t hospitals have some responsibility in this area with or without governmental regulation? Why don’t people like Ms. Gordon contact some hospitals, ask them what they are doing about it, and then write columns criticizing the ones that are being negligent?

To me, it’s a puzzlement.

Monday, September 18, 2006

Book Review

Bob Cathcart, one of the old lions of health care, has read a book that impressed him and is anxious to hear the comments of others.

Here is what he has to say:

About a week ago I finished reading the book, "Redefining Health Care,Creating Value-Based Competition on Results." The authors are Michael E.Porter and Elizabeth Olmsted Teisberg. During the past 58 years I have read many papers and books by economists proposing changes in the manner health care services in the United Statesare organized and provided. "Redefining Health Care" is the most refreshing,creative and imaginative set of proposals that I have found. The authors areable to define the problems that many of us can identify. Then they providepragmatic solutions for problems that we have struggled with for so manyyears. I wonder if many of us health care workers are too close to the health care mess and can't see the broad policy issues as well as"outsiders" can? I am impressed that "outsiders" Porter and Teisberg can see broad policy aspects and advise us on how to cope with them.

Have readers of your blog commented on this book?

Friday, September 15, 2006

The Gorbachev Syndrome

A few days ago, friends were telling us about some frustrations they had recently experienced while receiving health care. I tried to explain how what happened to them arose in part out of the way health care is organized and conducted, but had the feeling they were not really listening.

It later occurred to me – as, perhaps, should have been obvious all along – that Americans don’t want their health care system redesigned, or even seriously reformed. They like it the way it is. They just want it to work better.

It reminded me of Mikhail Gorbachev, the man who presided over the collapse of the Soviet Union. Mr. Gorbachev thought that with a better way of thinking, and with a willingness to be more open – what he called perestroika and glasnost - the government owned and operated economic system he headed could function successfully. He was wrong about that. The fault was more in the system itself than in the way it was managed.

In a way, the Gorbachev experience illustrates our attitudes toward health care. We think that if we can get the incentives right (as in pay-for-performance), or change the way of financing (like adopting some kind of single-payer program), or make better use of computers, or tinker with things in some other way, we can get our outmoded, undisciplined and unaccountable system of health care to provide reliably high quality care at reasonable cost. Not likely.

It is improbable that our health care system will collapse like the Soviet Union (although some alarmists suggest that it might). But if it is to perform in the way it can and should, there needs to be a fundamental change in the way it is organized and operated.

My suggestion is that we hold hospitals (by which I mean their trustees and executives) responsible and accountable for the cost and quality of care in their communities – including the care provided by physicians. Maybe there are better solutions. If so, let us hear them.

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