1. Communication is the problem, follow-through the example

The majority of problems in health care can be broadly defined as communication problems.  If you’ve ever listened to health care people talk health care troubles, communication is often explicitly mentioned.  It’s an, almost universally used blame for many issues.  But the problems are often poorly corrected.  That says one of two things: 1) the problem has been poorly defined, assessed, or 2) execution of improvement activities has been lackluster.  Neither alternative is particularly appealing.

The first step in correcting this situation (generally, solving health care’s problems—or opportunities if you prefer optimistic rhetoric) relates to alternative one above: recognizing that the issue at hand is one of a breakdown in communication.  What better way to do that than through examples?

Example 1: Following through

Ted Eytan recently blogged about a study that concluded 7.1% of the time, on average, information was not communicated to patients regarding abnormal test results.  What makes this even worse is the “no news is good news” doctrine:

It’s impressive that in 2009, believe it or not, there really aren’t firmly established processes for handling information about test results. A lot of what is done today is bred from custom, such as the infamous “no news is good news,” which the authors found was the protocol in 8 out of 19 medical practices studied. Everyone who likes this approach to test result notification, please raise your hand…

Here’s a real example from Disruptive Women (via Ted Eytan) of a communication breakdown.  Notice that policies and procedures were in place, the lack of follow-through is where the problem rose:

One year later, as Dr. Rosenthal walked into the exam room eyeing Sam’s medical record he stopped for a moment, raised his eyebrows and then looked sheepishly at Sam. “I’m sorry,” he said, “the pathology report from your surgery showed prostate cancer. And, I am afraid I did not see the report until now.” Sam was confused as to how that could have happened. Although he had not previously requested a copy of the report, he asked for one now.

After calming down, finding a new urologist, and making plans for the testing to find out how far the cancer had spread over the past year, Sam finally sat down and read the report. Typed in large, bold type across the top of the report was the following statement: “Results telephoned in to Dr. Rosenthal on 05/05/08? … one year prior to the visit. Turns out not only did Dr. Rosenthal have a copy of the report, he also had received a verbal notification that Sam’s pathology report showed cancer of the prostate. The hospital had a strict policy of calling the surgeon, in addition to faxing and mailing a copy of the report whenever there was a finding of cancer.