“Process ‘beats’ outcome,” hospital food tumblog

Hospitals should be scared of anecdotal stories.  The one time that surgery resulted in a mistake.  The one hospital stay with rude staff/patient interaction.  The one time that a communication breakdown between providers resulted in a longer stay.  Scared because the best (worst!) stories are powerful and they spread (and if it’s happened once, it’s likely happened again).  The “little” stuff matters, too.

Tom Peters, commenting on a Press Ganey survey, accurately writes:

(1) Process “beats” outcome in evaluating an “experience”—even one as apparently “outcome sensitive” as a hospital stay. The positive quality of staff interactions were more memorable than whether or not the health problem was fixed.
(2) Happy staff, happy customers. Want to “put the customer first”? Put the staff “more first”!
(3) Quality is free—and then some. We learned (well, most of us learned) when the “quality movement” dominated our consciousness that not only was quality free—but doing the quality thing right actually reduced costs, often dramatically.

With the attention being paid to patient satisfaction in hospitals today, it is interesting that organizations haven’t launched an all out assault on “process” elements (begging for 5s in Press Ganey’s patient satisfaction survey is far from such an effort).

Taking all of this into account, one might think that if a hospital appears on this Hospital Food tumblog (via Boing Boing), appropriate action would be taken.  Appropriate action, in this case, would be to completely reinvent the hospital food experience.

It’s A-L-L process “stuff” in the patient’s eyes.

Checklists in medical care seem like a great idea, right?

It has been about a month since Dr. Atul Gawande’s article “The Checklist” appeared in the New Yorker (if you go there to read the article, be prepared…it’s lengthy, but worth the time). If you don’t have the time check out Maggie Mahar’s slightly shorter summary here at Health Beat Blog.

The basic point of the story is this: Dr. Peter Pronovost instituted checklists while working at Johns Hopkins Hospital in critical care. And guess what happened? Dramatically improved care. AND it even saved money.

Dr. Pronovost proceeded to export his checklists throughout the state of Michigan and again a substantial number of patient lives were saved to go along with significant cost savings.

These great results were published in the New England Journal of Medicine and then checklists were rolled out across the country, right? You would think so. But it didn’t happen. In fact, as Ms. Mahar puts it: “In December of 2006, the results were published in The New England Journal of Medicine. How many U.S. hospitals have adopted checklists since? None.”

Why? Well it seems the answer is written here in an op-ed by Dr. Gawande in the New York Times. Ms. Mahar provides her always insightful analysis here and here. The federal agency Office for Human Research Protections is preventing the use of checklists.

That’s a tough pill to swallow. Here we have a health care innovation that saves lives and delivers significant cost savings but is unable to cut through government bureaucracy.

And then after all of that, in a slightly different vein, Reuters has a story from Hong Kong on the use of checklists.

UPDATE: Some more and more on checklists.