Saturday, May 24, 2008

Changing the Culture of Health Care

Twenty years ago, no sober-minded hospital administrator would have risked being accused of committing “interference in the practice of medicine” by promoting the adoption of standard methods for treating particular kinds of medical cases. And yet that practice is rapidly becoming common. According to a report in the May 12, 2008 issue of Modern Healthcare, Baylor Health Care System in Dallas has such standards in place, is working actively on forty of them, and has plans for as many as 300.

That reflects a remarkable change in the culture of health care, which is deeply entrenched and resistant to change.

While there are few if any recognized methods for changing culture, the Baylor experience (like that of other health care institutions) might give us a clue.

Adoption of clinical standards by Baylor started with the now legendary 1999 report of the Institute of Medicine titled To Err is Human, which said that tens of thousands of patients in the U.S. were dying every year as a result of preventable medical errors and suggested some steps that might be taken to deal with the problem. The herd instinct is strong in health care and Baylor did not want to be seen as being behind the times. Its first step was to appoint a Chief Quality Officer and things proceeded from there.

The initial standard adopted by Baylor dealt with the treatment of pneumonia. The rate of adherence to recommended practice went from 10-20% to 70-80% and hospital mortality from pneumonia dropped by 35%. It would take a formidable culture indeed to resist numbers like that.

It is worthy of note, I think that Baylor neither criticized the practices of its physicians nor undertook to change the culture. Had it (or anyone else) done either one, the resistance almost certainly would have been fierce.

Whatever objections there were to Baylor’s initiatives, and there undoubtedly were some, they could not prevail in the face of the seriousness of the issue being addressed and the effectiveness of the remedy adopted. And so the culture changed.

Discussions of health care reform often mention the need to change the culture of health care. Perhaps the lesson here is that the way to do that is not by trying to do so directly, but by addressing its undesirable consequences.

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