The Government as HR Manager
I never thought about the government as a Human Resources Manager until I started reading Chapter 11 of the textbook: Compensation Practices, Planning and Challenges. In particular, compensation is of interest in relation to the Medicare program. Fried and Fottler discuss compensation strategy and how to reward employees for performance in a way that is meaningful to them. As I thought about the ideas presented about compensation and how doctors might perceive their roles and positions, I began to wonder what their perspective is on the government as an HR Manager. Fried and Fottler state that, “organizations earn a reputation for the amount they pay employees.” Well, what type of reputation has the federal government earned in regard to Medicare reimbursement for physicians?
In my experiences of working with physicians overall, I can say that my perception is that doctors (especially primary care physicians) aren’t very fond of the Medicare reimbursement system. A common complaint of physicians participating in the program is that the reimbursement rates are way too low. And who can blame them? According to the Washington Post, doctors have been paid below market rates for DECADES. Current reimbursement rates are at 25 to 35% below commercial insurance. In fact, reimbursement has become such a sore point for physicians that 31% of primary care practitioners have chosen to limit Medicare patients within their practice. These doctors are fearful of more cuts—which they can pretty much count on because it happens nearly every year. Another 60% of doctors are at least entertaining the idea of removing Medicare from their practice entirely (Newman, 2010).
One of the biggest problems with the payment system is the fact that the way costs are calculated has not been updated in several years. Congress is very fearful of promising not to make cuts due to the huge financial costs. Apparently, freezing Medicare reimbursements for the next ten years (meaning no slashes to payments) would cost $276 billion. But, that’s just FREEZING costs…who knows what would happen if physicians actually started to be paid market value for services.
These reimbursement issues are a pretty big deal. More and more medical school graduates are choosing higher paying specialties—i.e. anything but primary care where reimbursement is often the lowest. The younger generation of physicians has caught on to the mess that is Medicare reimbursement. Patients that are privately insured are much more profitable, and young doctors will be opening practices right out of school that restrict heavy Medicare so not to get themselves involved with the conundrum that older physicians are in. It’s particularly difficult for older doctors to hire younger replacements if their practice is heavy with Medicare. Considering the fact that in Florida alone 60% of physicians are 50 or older, this could be a serious problem if younger physicians are unwilling to replace them (Fritz, 2002).
This issue is also pretty far-reaching into the future as practitioners speculate about what might happen once the nation goes to the new healthcare program in 2014. What kind of reimbursement can clinicians expect from the new system if Medicare is treating them so poorly? If enough doctors opt out of this new program access could end up being a huge problem—and the program was designed to improve access, right?
The bottom line is this: Nobody wants to work for free, including doctors. The government needs to figure out how to “reward employee performance” and “attract and retain high-performing employees” without breaking the bank (Fried & Fottler, 2008). But is that possible? Maybe the entire Medicare program needs a complete and total overhaul. In the future it’s not hard to see why doctors would “quit” Medicare and government programs altogether. Hopefully, the government will give our physicians more incentive to see Medicare patients. There’s nothing wrong with a little bit of optimism, but let’s just say I’m not holding my breath.
References
Fried, B.J. & Fottler, M.D. (2008). Human Resources in Healthcare: Managing for Success (3rd Ed.). Chicago: Health Administration Press.
Fritz, S. (7 October 2002). Young doctors may avoid Florida. Saint Petersburg Times, p. 3A.
Newman, M.A. (19 June 2010). A fix for the ‘doc fix.’ The Washington Post, p. A17.
Monday, November 29, 2010
Monday, October 25, 2010
Pay for Performance
Health reform discussions over the past couple of years (centered on the Obama/McCain election) have shed light on the state of healthcare in the U.S. for the American public. As policymakers and elected officials have attempted to rectify our somewhat broken healthcare system (it depends on who you ask) a topic that often comes up is healthcare quality. What can we do about quality and the fact that we spend so many dollars on healthcare for below average outcomes? The question has sparked plenty of debate. One suggestion for the quality problem relating specifically to physicians is pay for performance (P4P). This is highly controversial and criticized—especially among primary care physicians. A New York Times article addresses some of the key points of the discussion and a recent study related to P4P published in The Journal of the American Medical Association (JAMA).
The article opens with a primary care physician expressing his dissatisfaction of a letter from an insurance company that notified him of his “quality ranking.” The quality ranking is essentially a way for the insurance company to objectively and uniformly measure their physician partners. This doesn’t seem like a bad idea, actually. However, even though the doctor maintained a high quality ranking he was still unhappy with the system. His argument was that the insurance company shouldn’t assume that the way he practices medicine has any direct connection to patient outcomes. I’ll be completely honest. At first glance it sounds to me as though the doctor wants to make an excuse or “have an out” when quality in his office falls below average. The second thought I had is that doctors in general don’t typically like to be held accountable to anyone because the very nature of their profession offers a high level of autonomy. But it doesn’t make sense that outcomes aren’t correlated to physician care.
The doctor then went on to talk about a patient with high blood pressure that he’d been dealing with for several years. This particular patient couldn’t afford to take time off work for appointments and his argument was that he should not be accountable for her poor health because of her job situation. Okay, I can understand that. However, I believe that for most doctors situations like that are the exception and not the norm. I believe that most people want to obey the doctor’s orders—especially if they have a pretty severe condition. On some level I can understand why this doctor is irritated, but I don’t think the solution is to let all doctors “off the hook.” Performance management measures need to be in place for all employees including doctors.
The JAMA study discussed in The New York Times article reveals that WHO doctors are actually treating makes a difference in P4P rankings. For example, doctors that treat more minorities and non-English speaking or underinsured patients typically have lower quality scores when rankings are not adjusted for these factors. However, after adjusting for the type of patient that the doctor is typically treating, many of the lower ranking doctors increased their scores up to 10 points.
According to Fried and Fottler, performance management is essential because “you can’t manage what you can’t measure.” Physicians can be difficult to work with and they can definitely be difficult to manage—but even they need to be held accountable to some set standards. The goal of performance management is to create goals and an action plan to achieve them. Progress must be monitored to ensure that employees are on target, so set standards must be in place and enforced—even for doctors (Fried, 2008).
I realize that P4P is controversial and many healthcare practitioners believe that it should be done away with. However, I don’t think the solution is to throw the baby out with the bath water. P4P can work, there simply need to be adjustments in place to account for extreme differences in physician patient populations. It will be interesting to see if P4P effectively motivates physicians over time.
References
Chen, P.W. (1 October 2010). Paying doctors for patient performance. The New York Times. Retrieved October 25, 2010 from LEXIS-NEXIS Academic Database.
Fried, B.J. & Fottler, M.D. (2008). Human Resources in Healthcare: Managing for Success (3rd Ed.). Chicago: Health Administration Press.
The article opens with a primary care physician expressing his dissatisfaction of a letter from an insurance company that notified him of his “quality ranking.” The quality ranking is essentially a way for the insurance company to objectively and uniformly measure their physician partners. This doesn’t seem like a bad idea, actually. However, even though the doctor maintained a high quality ranking he was still unhappy with the system. His argument was that the insurance company shouldn’t assume that the way he practices medicine has any direct connection to patient outcomes. I’ll be completely honest. At first glance it sounds to me as though the doctor wants to make an excuse or “have an out” when quality in his office falls below average. The second thought I had is that doctors in general don’t typically like to be held accountable to anyone because the very nature of their profession offers a high level of autonomy. But it doesn’t make sense that outcomes aren’t correlated to physician care.
The doctor then went on to talk about a patient with high blood pressure that he’d been dealing with for several years. This particular patient couldn’t afford to take time off work for appointments and his argument was that he should not be accountable for her poor health because of her job situation. Okay, I can understand that. However, I believe that for most doctors situations like that are the exception and not the norm. I believe that most people want to obey the doctor’s orders—especially if they have a pretty severe condition. On some level I can understand why this doctor is irritated, but I don’t think the solution is to let all doctors “off the hook.” Performance management measures need to be in place for all employees including doctors.
The JAMA study discussed in The New York Times article reveals that WHO doctors are actually treating makes a difference in P4P rankings. For example, doctors that treat more minorities and non-English speaking or underinsured patients typically have lower quality scores when rankings are not adjusted for these factors. However, after adjusting for the type of patient that the doctor is typically treating, many of the lower ranking doctors increased their scores up to 10 points.
According to Fried and Fottler, performance management is essential because “you can’t manage what you can’t measure.” Physicians can be difficult to work with and they can definitely be difficult to manage—but even they need to be held accountable to some set standards. The goal of performance management is to create goals and an action plan to achieve them. Progress must be monitored to ensure that employees are on target, so set standards must be in place and enforced—even for doctors (Fried, 2008).
I realize that P4P is controversial and many healthcare practitioners believe that it should be done away with. However, I don’t think the solution is to throw the baby out with the bath water. P4P can work, there simply need to be adjustments in place to account for extreme differences in physician patient populations. It will be interesting to see if P4P effectively motivates physicians over time.
References
Chen, P.W. (1 October 2010). Paying doctors for patient performance. The New York Times. Retrieved October 25, 2010 from LEXIS-NEXIS Academic Database.
Fried, B.J. & Fottler, M.D. (2008). Human Resources in Healthcare: Managing for Success (3rd Ed.). Chicago: Health Administration Press.
Monday, September 27, 2010
Healthcare Performance Managment
Performance management is an area of confusion among most executives throughout the United States. Most organizations struggle to define how to measure their employees, often sticking to strict metrics as opposed to measuring performance based on a variety of behaviors and day to day tasks. According to Fried and Fottler, “Performance management is a set of tools and practices that comprises setting performance goals with employees, designing strategies with employees to make and sustain improvement…(2008). From this definition it is clear that performance management should be a coordinated effort that includes the input of the employee along with that of the manager and involves a plan to help the individual achieve success within the organization.
I worked for a large pharmaceutical company as a sales rep and one of the greatest complaints among the reps was how ridiculous the performance measurements were. The organization often focused on metrics like sales calls per day, the number of lunch appointments scheduled during a given week, or the number of doctors that attended dinner programs. These metrics were constantly emphasized, but none of these directly added any value to our customers or increased the bottom line. By focusing on tasks as opposed to customer satisfaction or sales, reps often became disillusioned with “busy work” without moving any real revenues.
Hospitals and other healthcare organizations call fall into the same trap by putting too much focus on things like the number of patients seen in an hour rather than focusing on the quality of care provided to those patients. Some metrics evaluations can be useful when they are not emphasized at the expense of other more important factors. Fried and Fottler provide guidelines that should be followed in determining the actual criteria to be used in performance management.
First, performance measurements should add value to the organization’s corporate goals. When I was working as a pharmaceutical rep, the company constantly stated that their goals were to add value to physicians and grow sales. However, their performance criteria usually highlighted metrics that did not necessarily enhance customer value or increase sales. For example, I remember one coworker in my area that was praised repeatedly for a high sales call average per day. This same sales rep was consistently ranked in the bottom in regard to actual revenue performance. This is a great example of focusing on performance measures that don’t necessarily add value to the company’s overarching goals.
This example also fits the second guideline from Fried and Fottler, which states that performance measurements should not focus solely on any given task or behavior. Criteria selection should take a multifaceted view of the employee’s total job description.
Finally, any measurements need to be within the realm of control of the employee. This means that external factors that staff members cannot influence should not negatively affect their performance evaluations. When I worked as a rep, there were always several offices that would not allow reps to come in due to physician time constraints. Regardless of how inaccessible these doctors were, we were still responsible for sales whether positive or negative, that came out of these physician offices.
Overall, every organization wants productive people. Executives want people that are committed to their work and add value to the bottom line. In order to set the team up for success, organizations have to get employee buy-in regarding how they are measured. Employees that feel they are unfairly evaluated may harbor anger and bitterness towards the company and their performance will decrease. If organizations want to get the most out of their people they need to involve them in the performance management process and work together towards a common goal.
References
Fried, B.J. & Fottler, M.D. (2008). Human Resources in Healthcare: Managing for Success. Chicago: Health Administration Press.
I worked for a large pharmaceutical company as a sales rep and one of the greatest complaints among the reps was how ridiculous the performance measurements were. The organization often focused on metrics like sales calls per day, the number of lunch appointments scheduled during a given week, or the number of doctors that attended dinner programs. These metrics were constantly emphasized, but none of these directly added any value to our customers or increased the bottom line. By focusing on tasks as opposed to customer satisfaction or sales, reps often became disillusioned with “busy work” without moving any real revenues.
Hospitals and other healthcare organizations call fall into the same trap by putting too much focus on things like the number of patients seen in an hour rather than focusing on the quality of care provided to those patients. Some metrics evaluations can be useful when they are not emphasized at the expense of other more important factors. Fried and Fottler provide guidelines that should be followed in determining the actual criteria to be used in performance management.
First, performance measurements should add value to the organization’s corporate goals. When I was working as a pharmaceutical rep, the company constantly stated that their goals were to add value to physicians and grow sales. However, their performance criteria usually highlighted metrics that did not necessarily enhance customer value or increase sales. For example, I remember one coworker in my area that was praised repeatedly for a high sales call average per day. This same sales rep was consistently ranked in the bottom in regard to actual revenue performance. This is a great example of focusing on performance measures that don’t necessarily add value to the company’s overarching goals.
This example also fits the second guideline from Fried and Fottler, which states that performance measurements should not focus solely on any given task or behavior. Criteria selection should take a multifaceted view of the employee’s total job description.
Finally, any measurements need to be within the realm of control of the employee. This means that external factors that staff members cannot influence should not negatively affect their performance evaluations. When I worked as a rep, there were always several offices that would not allow reps to come in due to physician time constraints. Regardless of how inaccessible these doctors were, we were still responsible for sales whether positive or negative, that came out of these physician offices.
Overall, every organization wants productive people. Executives want people that are committed to their work and add value to the bottom line. In order to set the team up for success, organizations have to get employee buy-in regarding how they are measured. Employees that feel they are unfairly evaluated may harbor anger and bitterness towards the company and their performance will decrease. If organizations want to get the most out of their people they need to involve them in the performance management process and work together towards a common goal.
References
Fried, B.J. & Fottler, M.D. (2008). Human Resources in Healthcare: Managing for Success. Chicago: Health Administration Press.
Monday, August 30, 2010
Culture is the Key
At nearly every company I have ever been employed, Human Resources (HR) was considered a four-letter word. Nobody wanted to have any interaction with HR. You didn’t want phone calls from them, you didn’t want any e-mails from them, you just wanted to stay off their radar. Typically, when people were contacted by the HR department they weren’t receiving good news.
I believe that most people view HR as a part of the organization that only looks for personnel that are breaking the rules. We all know that part of their job is to ensure that employees are compliant with the rules and regulations of the organization. However, I think in most companies more emphasis can and needs to be placed on some of the more enriching aspects of human resources.
HR should be the primary entity that focuses on the establishment and cultivation of company culture. This extends far beyond a thorough discussion on values during new employee training and orientation. Culture is ongoing and I believe that the responsibility for building a solid culture is often left up to the employees to execute on their own without much encouragement from anyone. The values of the organization serve as a guide for each individual and determine how they conduct themselves in regard to customers and other employees in the organization. HR executives should create programs that bring the values to life on a daily basis. That first starts with the leadership team, who should be modeling these behaviors each day.
I can’t tell you how many times I went to one boring corporate meeting after another only to watch the big wig executives “grand stand” on a stage about how important company values were. But if you asked any of the employees the majority would say that they didn’t feel valued at all and they didn’t feel like the company was representing its values well either. Most hadn’t received merit increases in over a few years. That wasn’t due to poor performance, it was due to the company’s lofty goals that were unrealistic for the economic environment we were all up against. It was just another meeting where we all pretended that we felt “empowered and valued” or whatever the new catch phrase was, but those qualities rarely described the environment we worked in on a daily basis.
HR should be constantly working to create a company culture that truly embodies the values that the organization seeks to represent. If that isn’t possible then either the leadership or the values themselves need to change. People don’t like working in environments that breed a culture of “say one thing and do another.” It’s dishonest, and I like to believe that most people are honest, they want to do what’s right and they want to work for people that also want to do what’s right.
I believe that most people view HR as a part of the organization that only looks for personnel that are breaking the rules. We all know that part of their job is to ensure that employees are compliant with the rules and regulations of the organization. However, I think in most companies more emphasis can and needs to be placed on some of the more enriching aspects of human resources.
HR should be the primary entity that focuses on the establishment and cultivation of company culture. This extends far beyond a thorough discussion on values during new employee training and orientation. Culture is ongoing and I believe that the responsibility for building a solid culture is often left up to the employees to execute on their own without much encouragement from anyone. The values of the organization serve as a guide for each individual and determine how they conduct themselves in regard to customers and other employees in the organization. HR executives should create programs that bring the values to life on a daily basis. That first starts with the leadership team, who should be modeling these behaviors each day.
I can’t tell you how many times I went to one boring corporate meeting after another only to watch the big wig executives “grand stand” on a stage about how important company values were. But if you asked any of the employees the majority would say that they didn’t feel valued at all and they didn’t feel like the company was representing its values well either. Most hadn’t received merit increases in over a few years. That wasn’t due to poor performance, it was due to the company’s lofty goals that were unrealistic for the economic environment we were all up against. It was just another meeting where we all pretended that we felt “empowered and valued” or whatever the new catch phrase was, but those qualities rarely described the environment we worked in on a daily basis.
HR should be constantly working to create a company culture that truly embodies the values that the organization seeks to represent. If that isn’t possible then either the leadership or the values themselves need to change. People don’t like working in environments that breed a culture of “say one thing and do another.” It’s dishonest, and I like to believe that most people are honest, they want to do what’s right and they want to work for people that also want to do what’s right.
Tuesday, July 13, 2010
A Quality Issue That Deserves Some Attention
For the summer I’m working as an intern at a medical device management company called Access MediQuip. My project for the summer is to create a well-researched report outlining the trends of the implantable medical device industry. Throughout my research I’ve come across some pretty interesting information.
I was completely unaware of how many products are recalled by device companies (or the FDA) in a given year. Already in 2010 there have been 23 recalls posted on the FDA’s website (2010). Comparing the list of recalls in recent years to that of 2001 to 2005, it appears that the number is growing and not declining. A Supreme Court ruling in 2008 could be the reason why.
In 2007 about 235,000 people were affected by the recall of MedTronic’s Sprint Fidelis. This is an accessory device called a lead that wires a defibrillator to the patient’s heart. In 2005, Guidant Corporation, had a similar recall due to defective defibrillators. At the time, both companies were facing a barrage of lawsuits from angry patients that had been affected by the potentially faulty devices. Because the devices had been approved by the FDA, going through the pre-market approval process, the Supreme Court ruled in 2008 that manufacturers are protected from lawsuits pertaining to malfunctioning devices. This is provided the company was not already aware that the products were unsafe.
So the injustice begins. Not only are there several thousand individuals still implanted with the Sprint Fidelis and other potentially faulty devices, but these people will not be entitled any recompense for the trouble and stress. It gets better. Patients that need to have the device removed because of its potential hazard are not guaranteed any reward by the manufacturer to help pay for corrective surgery costs. History reveals that manufacturers are not at all generous when it comes to financing what they’ve screwed up. Some will only pay for the actual device, not the cost to have the procedure done and many have refused even that. That leaves someone else to foot the bill. Sometimes it’s the private insurer, sometimes it’s the patient, and many times it’s the taxpayers. The implantable device demographic is largely an elderly population, meaning that most will qualify for Medicare.
I’m very surprised that this issue hasn’t garnered more attention. Not only does it unnecessarily increase healthcare costs, but it poses a huge quality problem for the patients. Judging from the increasing list of recalls from the FDA, it doesn’t appear that the quality issue will improve any time soon. Maybe that’s because device manufacturer’s have the protection of the Supreme Court on their side. What real incentive do they have to improve quality if there are no real consequences for the lack thereof? You would think that declining sales would provide enough motivation, but in the research I’ve seen manufacturer’s still manage to make huge profits even in the midst of recalls. I’m not saying that devices need to be perfect, because every product purchased is subject to some level of malfunctioning. However, device makers need to get some more skin in the game. The government needs to raise the stakes on companies by creating penalties for a certain percentage of faulty products and requiring device makers to pay for their mistakes instead of shifting the cost to taxpayers, patients, and private insurers.
References
(2010). List of Device Recalls. Retrieved July 13, 2010 from http://www.fda.gov/MedicalDevices/Safety/RecallsCorrectionsRemovals/ListofRecalls/default.htm
I was completely unaware of how many products are recalled by device companies (or the FDA) in a given year. Already in 2010 there have been 23 recalls posted on the FDA’s website (2010). Comparing the list of recalls in recent years to that of 2001 to 2005, it appears that the number is growing and not declining. A Supreme Court ruling in 2008 could be the reason why.
In 2007 about 235,000 people were affected by the recall of MedTronic’s Sprint Fidelis. This is an accessory device called a lead that wires a defibrillator to the patient’s heart. In 2005, Guidant Corporation, had a similar recall due to defective defibrillators. At the time, both companies were facing a barrage of lawsuits from angry patients that had been affected by the potentially faulty devices. Because the devices had been approved by the FDA, going through the pre-market approval process, the Supreme Court ruled in 2008 that manufacturers are protected from lawsuits pertaining to malfunctioning devices. This is provided the company was not already aware that the products were unsafe.
So the injustice begins. Not only are there several thousand individuals still implanted with the Sprint Fidelis and other potentially faulty devices, but these people will not be entitled any recompense for the trouble and stress. It gets better. Patients that need to have the device removed because of its potential hazard are not guaranteed any reward by the manufacturer to help pay for corrective surgery costs. History reveals that manufacturers are not at all generous when it comes to financing what they’ve screwed up. Some will only pay for the actual device, not the cost to have the procedure done and many have refused even that. That leaves someone else to foot the bill. Sometimes it’s the private insurer, sometimes it’s the patient, and many times it’s the taxpayers. The implantable device demographic is largely an elderly population, meaning that most will qualify for Medicare.
I’m very surprised that this issue hasn’t garnered more attention. Not only does it unnecessarily increase healthcare costs, but it poses a huge quality problem for the patients. Judging from the increasing list of recalls from the FDA, it doesn’t appear that the quality issue will improve any time soon. Maybe that’s because device manufacturer’s have the protection of the Supreme Court on their side. What real incentive do they have to improve quality if there are no real consequences for the lack thereof? You would think that declining sales would provide enough motivation, but in the research I’ve seen manufacturer’s still manage to make huge profits even in the midst of recalls. I’m not saying that devices need to be perfect, because every product purchased is subject to some level of malfunctioning. However, device makers need to get some more skin in the game. The government needs to raise the stakes on companies by creating penalties for a certain percentage of faulty products and requiring device makers to pay for their mistakes instead of shifting the cost to taxpayers, patients, and private insurers.
References
(2010). List of Device Recalls. Retrieved July 13, 2010 from http://www.fda.gov/MedicalDevices/Safety/RecallsCorrectionsRemovals/ListofRecalls/default.htm
Tuesday, June 22, 2010
Who Says It's An Adverse Event?
In determining whether or not an adverse event has occurred in the healthcare setting I believe that both the patient’s perspective and the physician’s perspective are very important. It’s difficult, if not impossible to choose only one perspective in evaluating these events.
If I take the definition of The Healthcare Book, the credo for patient safety is “freedom from accidental injury.” I like this definition because it’s pretty straightforward. If the patient is injured accidentally, regardless of the good intentions of the doctors and the risk involved with the procedure—unintentional injury to the patient in any form is an adverse event. Even if the procedure was performed correctly and everything possible was done in good faith to preserve the health of the patient, if an injury occurred or the patient was harmed, I believe that qualifies as an adverse event. I think that it’s important to acknowledge the harm in patients even when procedures are correctly performed and injury is perhaps unpreventable. To not acknowledge the injury to the patient is to accept the issues surrounding the treatment as status quo and there is little incentive to improve healthcare quality.
In determining whether or not an adverse event has actually occurred, it is important to consider the patient and the practitioner’s perspective. Some patients may perceive that they have been the victim of an adverse event when one hasn’t actually happened. If we go back to the definition in The Healthcare Quality Book, I think it’s safe to say that if the patient was not accidentally injured in some way, it’s not an adverse event. A patient might have an emotional scare (i.e. being read the wrong lab results), but if the individual is not actually physically harmed the event should not be reported as adverse. Still, healthcare organizations can learn a lot from slip ups like reading the patient the wrong lab results. Patient complaints of issues in a healthcare facility shouldn’t be ignored, but they also shouldn’t be the final word.
Doctor perspective also should not be the only determining factor on whether or not an adverse event has occurred. Doctors and medical staff typically do not report events at the rate that they occur. Quite the contrary, the number of events reported is far lower than the actual events that happen. This is mostly because health care organizations have not created a “safe” culture for providers to report these issues without fear of disciplinary action. Therefore, physicians and healthcare staff may be more likely to keep adverse events quite to protect themselves.
In order to truly determine if a patient did not receive appropriate care or was accidentally injured, there will likely need to be an investigation by the organization and in some cases state or federal authorities. In any event, the word of the patient and health care provider should be weighed carefully, but the verdict would need to be delivered after a pretty through evaluation of what actually happened. This protects both the patient and the provider.
If I take the definition of The Healthcare Book, the credo for patient safety is “freedom from accidental injury.” I like this definition because it’s pretty straightforward. If the patient is injured accidentally, regardless of the good intentions of the doctors and the risk involved with the procedure—unintentional injury to the patient in any form is an adverse event. Even if the procedure was performed correctly and everything possible was done in good faith to preserve the health of the patient, if an injury occurred or the patient was harmed, I believe that qualifies as an adverse event. I think that it’s important to acknowledge the harm in patients even when procedures are correctly performed and injury is perhaps unpreventable. To not acknowledge the injury to the patient is to accept the issues surrounding the treatment as status quo and there is little incentive to improve healthcare quality.
In determining whether or not an adverse event has actually occurred, it is important to consider the patient and the practitioner’s perspective. Some patients may perceive that they have been the victim of an adverse event when one hasn’t actually happened. If we go back to the definition in The Healthcare Quality Book, I think it’s safe to say that if the patient was not accidentally injured in some way, it’s not an adverse event. A patient might have an emotional scare (i.e. being read the wrong lab results), but if the individual is not actually physically harmed the event should not be reported as adverse. Still, healthcare organizations can learn a lot from slip ups like reading the patient the wrong lab results. Patient complaints of issues in a healthcare facility shouldn’t be ignored, but they also shouldn’t be the final word.
Doctor perspective also should not be the only determining factor on whether or not an adverse event has occurred. Doctors and medical staff typically do not report events at the rate that they occur. Quite the contrary, the number of events reported is far lower than the actual events that happen. This is mostly because health care organizations have not created a “safe” culture for providers to report these issues without fear of disciplinary action. Therefore, physicians and healthcare staff may be more likely to keep adverse events quite to protect themselves.
In order to truly determine if a patient did not receive appropriate care or was accidentally injured, there will likely need to be an investigation by the organization and in some cases state or federal authorities. In any event, the word of the patient and health care provider should be weighed carefully, but the verdict would need to be delivered after a pretty through evaluation of what actually happened. This protects both the patient and the provider.
Tuesday, June 8, 2010
I Know It When I See It
One of the most interesting aspects of working for a healthcare organization and learning in the HSA program is the ability to gauge whether or not my company actual subscribes to the principals discussed in my classes. It’s actually quite funny that many of the philosophies regarding healthcare quality and strategy are simply ignored by my organization. I would give them the benefit of the doubt and say they don’t know any better, but they’re one of the largest pharmaceutical companies in the world—yet even they have neglected some of the core principles of what not to do when you’re trying to create a high quality organization.
I like Guaspari’s little short story called, I Know It When I See It. It was funny that the “product” of choice was actually punctuation, but I got the gist of the story. What I’ve observed in my company and other large pharmaceutical organizations is exemplified in The Boss’s initial reaction to the success of Process Inc.: “Try harder. Do better.” As ridiculous as it is to read in the story, I’ve actually encountered that attitude first hand from management within my company and I’ve heard similar stories from other reps. The reality is that pharma is a dying industry and most companies were not prepared for the rapid decline of profits (due to patent expiration and generic competition). Rather than take a look at the flaws within the system as a whole, it must be easier to simply tell employees to try harder and do better. Just like Guaspari’s short story, that “direction” from management leads to decreased morality and productivity and exacerbates already existing problems within the company.
After The Boss realizes that “Try harder, do better” adds no value to the organization, he comes up with a plan to implement more inspection within the organization. Ironically enough, my company did the same thing. They’re idea was to mandate more activity—indirectly, this is a way of inspecting the quality of the sales rep’s work ethic and therefore profitability of the organization. How many calls per day were made, how many dinner programs and lunches were set up with doctors. These ridiculous mandates not only ticked off our physicians at times, but they were a waste of energy because people couldn’t focus on what would actually make a difference in the business. The job of a pharma rep represents a non-traditional view of healthcare quality, however it can still be judged as an aspect of quality in relation to the organization. Doctors measure quality not just by the characteristics of the products that reps sell, but the overall interaction with them as well as the pharmaceutical organization.
Eventually, The Boss at Punctuation, Inc. figured out that the problem with his company was within the system. It’s smarter to take an approach of prevention rather than putting out fires. He was eventually able to return his organization to a profitable powerhouse. I do believe that the pharmaceutical industry is attempting to restructure itself due to the fact that it’s a very broken system and profits (at least for my company) have not been reaching projections. They’ll probably eventually get it right, but they’ve wasted a lot of time and money in the process. It just proves the point that quality issues are not necessarily attributable to one source—they typically result from problems within the entire system.
I like Guaspari’s little short story called, I Know It When I See It. It was funny that the “product” of choice was actually punctuation, but I got the gist of the story. What I’ve observed in my company and other large pharmaceutical organizations is exemplified in The Boss’s initial reaction to the success of Process Inc.: “Try harder. Do better.” As ridiculous as it is to read in the story, I’ve actually encountered that attitude first hand from management within my company and I’ve heard similar stories from other reps. The reality is that pharma is a dying industry and most companies were not prepared for the rapid decline of profits (due to patent expiration and generic competition). Rather than take a look at the flaws within the system as a whole, it must be easier to simply tell employees to try harder and do better. Just like Guaspari’s short story, that “direction” from management leads to decreased morality and productivity and exacerbates already existing problems within the company.
After The Boss realizes that “Try harder, do better” adds no value to the organization, he comes up with a plan to implement more inspection within the organization. Ironically enough, my company did the same thing. They’re idea was to mandate more activity—indirectly, this is a way of inspecting the quality of the sales rep’s work ethic and therefore profitability of the organization. How many calls per day were made, how many dinner programs and lunches were set up with doctors. These ridiculous mandates not only ticked off our physicians at times, but they were a waste of energy because people couldn’t focus on what would actually make a difference in the business. The job of a pharma rep represents a non-traditional view of healthcare quality, however it can still be judged as an aspect of quality in relation to the organization. Doctors measure quality not just by the characteristics of the products that reps sell, but the overall interaction with them as well as the pharmaceutical organization.
Eventually, The Boss at Punctuation, Inc. figured out that the problem with his company was within the system. It’s smarter to take an approach of prevention rather than putting out fires. He was eventually able to return his organization to a profitable powerhouse. I do believe that the pharmaceutical industry is attempting to restructure itself due to the fact that it’s a very broken system and profits (at least for my company) have not been reaching projections. They’ll probably eventually get it right, but they’ve wasted a lot of time and money in the process. It just proves the point that quality issues are not necessarily attributable to one source—they typically result from problems within the entire system.
Tuesday, May 25, 2010
How Should We Define Quality in Healthcare?
If I had to define what quality means in the most general sense, it would be how well something satisfies my expectations. When I go grocery shopping at Whole Foods (my favorite grocery store) I expect the quality of the produce as well as the selection to be at a certain level—superior to what I might find in a Wal-Mart or Target produce section. My guess is that my expectation of Whole Foods is derived from my experiences there and fact that the groceries are more expensive—but that’s just the price of eating organic.
Even though my previous definition of quality is a suitable measure for Whole Foods and other retailers or businesses, it doesn’t work so well when it’s applied to healthcare. Measuring health care quality against patient satisfaction alone is very short-sighted. The problem is that when it comes to the science of medicine, patients don’t really know what to expect. They know that a receptionist should be kind and courteous and that they shouldn’t have to wait two hours to see the doctor, but they don’t necessarily know what medications or therapeutic approaches would be best for their condition. They’re trusting the doctor who went to medical school to tell them that. Doctors are brilliant people, but they’re still human and capable of making errors that can result in reduced quality for the patient.
I like the Institute of Medicine’s (IOM) definition of quality: “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Ransom, 2008). That sums up the definition of quality nicely, I think. If the doctor is practicing evidence-based medicine by following the protocol of current research, then regardless of the outcome the patient is getting the best quality of care that the medical community knows how to give.
The IOM definition is appropriate in terms of simply defining quality, but the six dimensions of quality as illustrated in Crossing the Quality Chasm reveal more insight on how to actually measure it. The six characteristics of quality answer this question: Is the healthcare delivery safe, effective, efficient, timely, patient centered, and equitable? If the answer is yes then it’s probably safe to say that the care the patient received was of high quality (Ransom, 2008).
In the wake of the healthcare reform, many Americans are wondering how the new legislation will affect healthcare quality. I’m actually wondering the same thing. As a pharmaceutical rep, I interact with primary care physicians every day. Many of them are already struggling under a demanding patient load and reimbursement cuts make it financially difficult for these doctors to see fewer patients. I think that the quality of care is already suffering in these offices due to time constraints, and it makes me wonder what will happen to healthcare quality overall once the whole bill is in effect.
Another interesting aspect of healthcare quality is the integration of new technology, a service feature that the U.S. health system is never short on. Lighter and McLaughlin make important points in The Rationale for Quality Improvement in Healthcare. They discuss the conundrum that the health care system is in regarding the demand for new technology by the consumer and the cost-containment pressures that come from several different sources. Culturally, I think that Americans are conditioned to believe that more is better. There seems to be this preconceived notion that if something costs more then that inherently makes it better quality than a comparable, but less expensive product or service. This mentality might have filtered into the healthcare system as well.
Even though state of the art technologies are in demand from consumers, the reality is that we can’t afford it as a nation. The pressure to get costs under control has resulted in a managed care system that is sometimes a bit too restrictive for the provider’s taste. Lighter and McLaughlin state, “Observing the effects of cost containment on patient utilization patters, providers often express concern that payers sacrifice quality for reduced cost.” There seems to be a very fine line between ensuring quality and controlling overall costs. What’s even more complicated is the fact that healthcare is still a business and organizations are focused on the bottom line which isn’t always in the best interest of the patient.
The U.S. definitely needs a better system of “checks and balances” so that more patients receive higher quality of care. The question is, how do we create that system and what does it look like? Hopefully, I’ll have a better understanding once I complete this summer semester.
References
Ransom, E., Joshi, M., Nash, D., & Ransom, S. (2008). The Healthcare Quality Book (2nd Ed.). Chicago: Health Administration Press.
Lighter, D., McLaughlin, C. The Rationale for Quality Improvement in Healthcare.
Even though my previous definition of quality is a suitable measure for Whole Foods and other retailers or businesses, it doesn’t work so well when it’s applied to healthcare. Measuring health care quality against patient satisfaction alone is very short-sighted. The problem is that when it comes to the science of medicine, patients don’t really know what to expect. They know that a receptionist should be kind and courteous and that they shouldn’t have to wait two hours to see the doctor, but they don’t necessarily know what medications or therapeutic approaches would be best for their condition. They’re trusting the doctor who went to medical school to tell them that. Doctors are brilliant people, but they’re still human and capable of making errors that can result in reduced quality for the patient.
I like the Institute of Medicine’s (IOM) definition of quality: “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Ransom, 2008). That sums up the definition of quality nicely, I think. If the doctor is practicing evidence-based medicine by following the protocol of current research, then regardless of the outcome the patient is getting the best quality of care that the medical community knows how to give.
The IOM definition is appropriate in terms of simply defining quality, but the six dimensions of quality as illustrated in Crossing the Quality Chasm reveal more insight on how to actually measure it. The six characteristics of quality answer this question: Is the healthcare delivery safe, effective, efficient, timely, patient centered, and equitable? If the answer is yes then it’s probably safe to say that the care the patient received was of high quality (Ransom, 2008).
In the wake of the healthcare reform, many Americans are wondering how the new legislation will affect healthcare quality. I’m actually wondering the same thing. As a pharmaceutical rep, I interact with primary care physicians every day. Many of them are already struggling under a demanding patient load and reimbursement cuts make it financially difficult for these doctors to see fewer patients. I think that the quality of care is already suffering in these offices due to time constraints, and it makes me wonder what will happen to healthcare quality overall once the whole bill is in effect.
Another interesting aspect of healthcare quality is the integration of new technology, a service feature that the U.S. health system is never short on. Lighter and McLaughlin make important points in The Rationale for Quality Improvement in Healthcare. They discuss the conundrum that the health care system is in regarding the demand for new technology by the consumer and the cost-containment pressures that come from several different sources. Culturally, I think that Americans are conditioned to believe that more is better. There seems to be this preconceived notion that if something costs more then that inherently makes it better quality than a comparable, but less expensive product or service. This mentality might have filtered into the healthcare system as well.
Even though state of the art technologies are in demand from consumers, the reality is that we can’t afford it as a nation. The pressure to get costs under control has resulted in a managed care system that is sometimes a bit too restrictive for the provider’s taste. Lighter and McLaughlin state, “Observing the effects of cost containment on patient utilization patters, providers often express concern that payers sacrifice quality for reduced cost.” There seems to be a very fine line between ensuring quality and controlling overall costs. What’s even more complicated is the fact that healthcare is still a business and organizations are focused on the bottom line which isn’t always in the best interest of the patient.
The U.S. definitely needs a better system of “checks and balances” so that more patients receive higher quality of care. The question is, how do we create that system and what does it look like? Hopefully, I’ll have a better understanding once I complete this summer semester.
References
Ransom, E., Joshi, M., Nash, D., & Ransom, S. (2008). The Healthcare Quality Book (2nd Ed.). Chicago: Health Administration Press.
Lighter, D., McLaughlin, C. The Rationale for Quality Improvement in Healthcare.
Saturday, May 22, 2010
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