Month: November 2009

It is the hospital.

Mark Hurst writes …:

Matt’s story about his hospital visit is instructive on two levels. First, his experience mirrors what is said all too often about the hospital patient experience: medical staff, even if capable and effective, don’t create an efficient or especially comfortable environment.

… about Matt Haughey’s “adventure in brain tumors:”

I came away from this experience feeling the OHSU hospital in Portland continues to impress me with its amazing staff, but that the process of dealing with patients could be done in a more efficient manner. I know they all sort of kept an internal log of my story but to constantly be asked the same things by different groups of people and then not know who is your main decision maker was a challenge. Given my state of sickness and exhaustion, I felt like what an elderly man might feel like in the medical system. I had trouble understanding what people were saying as they woke me from sleep, I was constantly poked and prodded without descriptions of what results entailed, I literally wanted to “phone a friend” when those surgeons asked me in the early morning hours what I wanted to do.

It’s an insightful perspective on the majority of healthcare’s inability to effectively relate to the patient’s experience.  Yes, safety comes first and those processes (checking patient identification…) will forever remain in place (as long as they are necessary).  But we certainly struggle to grasp the patient’s view of care–the macro individualized experience.

No, it’s not nursing and medicine and lab and food and pharmacy and radiology and environmental services and the operating room, etc.

It is the hospital.

Solving Problems Today

John Halamka, the uber healthcare CIO, is experimenting with his calendar:

The same thing can be applied to our administrative lives. Each day there are challenges created by customers, employees, and the external world. If we left 50% of our calendars open each day for solving today’s problems today, we would reduce stress, enhance communication, and improve efficiency. We could even develop metrics for senior executives which measure “time to problem resolution” as a means to drive incentive compensation.

Today, we pay doctors for quantity of care delivered instead of quality. Healthcare reform is intended to change that. Administratively, we should be paid for the problems we solve, the chaos we eliminate, and the processes we improve.

Understandable: primary care visit times increase

This study appearing in Archives of Internal Medicine (out last week) found that primary care physicians have increased the amount of time they spend with patients by about three minutes between 1997 and 2005.

It was a result, in both the mainstream media and the not-so-mainstream media, presented with amazement, astonishment, and awe.

Well, I operate under the assumption that physicians are generally pretty good people.  When the job at hand requires additional time in order to be completed professionally, they’ll do just that.  Older, more complicated, and more empowered patients take more time to care for.  As patients become older, more complicated, and more empowered the time required to care for them will continue to increase as medicine provides care with the methods and technology it has used for years.