Sunday, December 28, 2008

Commitment is a Team Effort

“Emergency room waits are decreasing at some Massachusetts hospitals as they prepare to comply with a new state rule that, as of New Year’s Day, will prohibit swamped ERs from turning away ambulances.”

That is the opening sentence of a story that appeared in The Boston Globe on December 24 under the by-line of veteran medical reporter Liz Kowalczyk.

Paul Dwyer, director of healthcare safety and quality, is the state health department official who issued the order. He is quoted as saying “The key is commitment from senior management.”

That statement is correct but doesn’t tell the whole story. Specifically, it ignores the essential role played by people like Dwyer himself and reporter Kowalczyk.

The problem has not been so much a lack of commitment as a lack of public support for senior hospital management that undertook to involve itself in clinical matters and to go contrary to the historical physician/hospital bias against emergency rooms.

For example, the article mentions that certain hospitals now “[suspend] teaching rounds when the ER is overflowing and doctors are urgently needed to discharge patients on the floors.” In the not-so-distant past, no senior manager would have dared to have suggested such a thing.

What now allows senior management to demonstrate a commitment to improvement is the change in public attitudes exemplified by Kowalczyk’s reporting and Dwyer’s rule-making. This reporting and rule-making – also impossible not so long ago – converts the change in public attitudes into pressure on hospital trustees, causing them to charge senior management with responsibility for corrective action and to provide support in the face of any internal opposition.

People like Kowalczyk and Dwyer need to appreciate the role they play in all this. Their function of reflecting and forming public beliefs and perceptions plays a key part in enabling hospital management and governance to implement the reforms that are so greatly needed.

It seems that commitment, too, is a team effort.

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