Blog | Tuesday, July 7, 2015

A failure to address the fundamental questions in health care


In the world of health care, we face a lot of questions and challenges. Hospital administrations across the country are grappling with these and always on the lookout for solutions. As far as raising the standard of health care quality, there's been great progress over the last several years in the areas of patient safety, adhering to best practices, and trying to improve our patients' health care experience. All of this of course against the backdrop of a big financial squeeze from the top (perhaps the biggest challenge).

I've been involved myself in hospital administration before deciding that it wasn't quite my cup of tea, and sat in on numerous meetings where I've watched health care administrators brainstorm and try their best to come up with better ways of doing things. And even without a formal administrative title, most hospital physicians now end up being involved in some committee or another, and get a chance to see close up how these high level decisions are made that greatly affect the clinicians at the coalface.

One observation of mine that I'd like to focus on, that I've always tried my best to weigh in with during meetings, is that a big mistake that hospital administrators make is to deal with the downstream effects of any given problem and not get to the source of exactly what's causing the issue. In other words, there is often a failure to address the fundamental question. Let's take an example: improving patient satisfaction and the health care experience.

The default way of thinking is to immediately ask the question: what can we do to improve hospital experience for our patients? This leads to answers such as appointing a “Patient Satisfaction Officer”, conducting slightly tacky face-to-face patient surveys, and frequently doing other rather gimmicky things such as getting doctors and nurses to wear “Have a Nice Day” badges (Yes, that seriously happened somewhere I've worked before!).

The error here was the innate tendency to jump straight into adding solutions to an imperfect system. The correct way to proceed would have been to address the fundamental question—namely, “We know that health care consists of dedicated professionals, so what barriers exist to them providing their patients a better experience?”

Here lies the source of the problem. The answers are more apparent by going this route, and are along the lines of: doctors and nurses not having enough time with patients, being overwhelmed with documentation requirements and information technology data entry tasks, perhaps needing a brush-up on communication skills (the biggest driver of patient satisfaction), being clearer with patients on wait times and what's wrong with them, and making hospitals into a less “rough and tumble” environment with more time to rest and recover in peaceful surroundings. A different question asked, but you get to the answers more easily.

The above example can be applied to a number of different health care problems. In fact, the same principle holds true in business and even politics. Without getting to the central issue, you will always be chasing your tail and coming with answers to an imperfect question. So as we move forward in health care, let's be sure to always be asking those fundamental questions.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.