Quality

Improving Quality

I’m reading Stephen Pinney‘s book called How Hockey can Save the Healthcare System and highly recommend it. Why?

The section on Quality addresses one of the most important lessons for Administrators….don’t always trust your reports. Dr. Pinney highlights the problem in his example with the Pre-Operative Surgical Checklist.

According to the Administrator, the checklist was preformed consistently for two years without issue. The problem was that it wasn’t performed correctly. Significant errors resulted and were unreported.

One of the most important lessons that I have learned from working closely with Medical Directors is that they know the business. When they say something is wrong, something is likely wrong. Administrators need to dig into the details to get to the bottom of the issue rather than dismissing them.

Interestingly, Dr. Pinney and I have uncovered the same issue. Data is often missing and when data is missing – the reports are wrong. Administrators need to understand why the data is missing and take the steps needed to ensure it is consistently captured. It’s a matter of life and limb – literally.

According to Dr. Pinney, these types of quality and process improvements are key to systematizing medicine and achieving the third aim. However, it all starts with accurate data.

Post: Rules

Not all rules are made to be broken.

The healthcare industry has always struggled with patient compliance. Many patients stop taking a prescription or adhering to a care plan as soon as they starting feeling better.

It’s a huge problem for physicians trying to adopt value based care models because non-compliant behavior often results in the need for more healthcare. Under value based care that additional care is provided at the physician’s expense. No wonder physicians are not keen on the new risk models.

Ideally every American should understand how they respond to rules.  However, it’s likely another thing that physicians need to address with patients to increase compliance.

There are 4 responses to rules:

1. Upholders: Uphold all rules both outer and inner.

2. Questioners: Questions all rules and uphold only the rules that make sense to them.

3. Rebels: As the name implies, they resist all rules.

4. Obligators: They are motivated by outer rules but not inner rules.

EMR companies should consider updating Patient Registration screens to capture patient’s rule behavior and to identify the Questioners and Rebels who are less likely to comply with meds and care plans. Rule behavior should also be factored into reporting and payment to avoid penalizing physicians.