December 30, 2004

Hospitals Arrive at the 20th Century

Virginia Postrel notes this article in the New York Times on a radical concept ... measuring your performance. Really, millions of people, hundreds of """"""experts"""""" will read this and consider it some sort of big deal.
And it is a response to a sobering reality: lifesaving treatments often are forgotten while doctors and hospitals lavish patients with an abundance of care, which can involve expensive procedures of questionable value. The results are high costs, unnecessary medicine and wasted opportunities to save lives and improve health.

For example, the hospitals were asked how often their heart attack patients got aspirin when they arrived (that alone can cut the death rate by 23 percent). When they were discharged, did they also get a statin to lower cholesterol levels? Nearly all should, with the exception of patients who have had a bad reaction to a statin and those rare patients with very low cholesterol levels. Did they get a beta blocker? (No)

Once hospitals learned their score, it was up to them what to do. Over the next year, ones that improved in these measures saw their patient mortality from all causes fall by 40 percent. Those whose compliance scores did not change had no change in their mortality rate, and those whose performance fell had increases in their mortality rates.

"Those are the most remarkable data I have ever seen," said Dr. Eric Peterson, the Duke researcher who directed the study and has reported on it at medical meetings.

The new efforts to improve care came about because the time was right, health care researchers say. "It's really an accumulation of scientific knowledge about what quality means," Dr. Califf said. And there was a growing realization that quality care was not always being provided

The new initiatives have one thing in common - they abandoned the traditional assumption that if doctors know what works, they will provide it
What a bunch of BS. This is not "scientific knowledge." This is basic industrial quality control. Nobody in Real Business makes those "traditional assumptions." Who in the world thinks in such naive terms - that a prescribed course of action just magically goes forward without monitoring and control? Where were these people during the 1980s Quality Revolution?.

This next part is priceless.
The solution, Dr. Gross said, was to assign specially trained nurses to see what care was provided and remind doctors when important steps were omitted. The result was immediate improvement, Dr. Gross said, even in items not on Medicare's list
You've got to be kidding me. I'll take a 3rd Grader with a checklist and do just as well.

Again, the articles goes one to describe the root causes..
Doctors do know what works, said Dr. Steven M. Asch, a health care researcher at the V.A. Greater Los Angeles Health Care System and the RAND Corporation in Santa Monica. But, he found, Americans got just half the tests and treatments they should be getting.

"Basically, it was a flip of coin, whether you got good medical care or you didn't," Dr. Asch said. "It didn't matter where you lived. The shortfalls were constant."
This kind of operational performance would bankrupt your average free-market industrial company. We all learned a long time ago that you have to do both things well: Design (diagnosis & prescription) and Manufacturing (treatment). This analogy holds very well.

For half my career, I have been on the operations/execution side of Corporate America. The best design, the best diagnosis to a customer problem, the brightest engineer in the world ... these things are worth NOTHING if they aren't actually implemented and executed at a high rate of quality.

Why am I even writing about this? Why is the New York Times? This is CLASSIC Deming, classic Juran, classic TQC, and of course mainstream Six Sigma.: Measure what you say you'll do.

Of course chaotic creativity, intelligence, innovation, still need to go into the what you do and how you do it. What's the best design approach, what's the best course of treatment?. But this article isn't even referring to that ... it assumes that has already been decided (decided by 'consensus' and the government -- good grief, what will free-market folks say about this ...see the companion post)

No, this whole article is telling us that our high priced health care system ... the best in the world, needs the Federal Government, of all things, to incentivize hospitals to check whether we receive the prescribed treatment Well I guess "better late then never" applies here, but I truly believe government intrusion into healthcare shielded hospitals from a Free Market that would have forced this on them a long time ago.

So the government is now trying to fix a problem it created. What's their record on that...0 for 10,000?