A blind man who appeared in a television commercial asking New York Gov. David A. Paterson, who is also legally blind, "Why are you doing this to me?" has been taken out of an advertising campaign paid for by healthcare interest groups. The move represents a softer approach by 1199 SEIU United Healthcare Workers East and the Greater New York Hospital Association, who have mounted a multimillion-dollar media campaign against the governor's budget proposal. Paterson, who has proposed trimming $3.5 billion from the state's healthcare budget, has said that the cuts are necessary, given the projected deficit of more than $13 billion for the coming fiscal year.
In a report from the House Committee on Appropriations, the committee outlines its rationale for including $1.1 billion for "comparative effectiveness research" in the massive economic stimulus bill. The research is "that done by doctors and statisticians who troll through large number of patient records to determine, for any particular disease, which treatments work best," says Washington Post columnist Steven Pearlstein. He says that while there's nothing particularly new about comparative effectiveness research, to some the wording in last month's House report was anything but innocuous.
The quality portion of the HealthLeaders Media Industry Survey 2009 offers insight into various aspects of healthcare quality—everything from infection control staffing levels to senior leaders' opinions—on the biggest barriers to improvement.
I am not a technophobe. I surf the Internet and listen to my iPod and watch digital TV just like the next fellow. Nevertheless, I also believe that technology can sometimes create barriers even as it spawns possibilities, and generate a false sense of security even as it protects us from bad things.
And so as much as electronic medical records, bar coding, radio frequency identification, and a host of other innovations have done to advance the cause of providing better, safer healthcare to patients, I confess I'm not entirely disappointed to see a growing emphasis on the fundamental human aspects of quality improvement.
In our HealthLeaders Media Industry Survey 2009 released this week, chief quality officers, chief nursing officers, and other executives charged with leading the quality and patient safety efforts at their organizations offered some intriguing thoughts on the role of technology in improving quality:
The best way to combat the spread of infections? Not even close—72% said hand washing.
When asked how effective EMR systems have been in improving quality and patient safety at their organizations, only 12% said an EMR was vital.
Thirty-three percent said their organization doesn't even have an EMR.
When asked to rate the effectiveness of eight measures in improving physicians' quality of care on a scale ranging from strongly effective to not effective, respondents' top answer was strongly effective for three of them: improved communication among doctors and hospitals, spending more time with patients, and a stronger focus on prevention and education.
Some notably low-tech perspectives, to be sure. The expanding awareness of the importance of seemingly simplistic practices can be seen elsewhere, as well. I talked to a quality leader at a California hospital for a story in the February issue of HealthLeaders magazine, also out this week, who told me her hospital cut medication errors by 20% in 30 days by having nurses wear vests when dispensing medications. Twenty percent in 30 days—just by creating a simple signal that certain people are not to be bothered when they're performing a certain task. And in the Wall Street Journal, I read a piece last week about how the Centers for Disease Control and Prevention says unsafe injection practices like reusing syringes are a leading cause of infections in physician offices and outpatient facilities. Reusing syringes? Seriously?
I know plenty of you could cite a litany of concrete improvements that provider organizations have realized from implementing high-tech initiatives. I know plenty of you would say that technology holds great promise for improving quality on a broad scale while also boosting efficiency and eliminating waste. And you'd be right on all counts. Technology can do a lot. But it can't do everything. Even if you have the most advanced computerized process in the world in use at your organization, it can still be undermined when human beings forget to wash their hands or don't dispose of a syringe or talk in the ear of a nurse who's dispensing medications.
The good news is that more and more healthcare leaders seem to be realizing the importance of addressing both the technological and human elements of quality improvement. Striking the proper balance between the two is the real challenge.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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A study looking at 15 care coordination programs involving Medicare patients found that only two resulted in a change in hospitalization rates—and one of those two saw more hospitalizations. According to the study, published in the Journal of the American Medical Association, viable care coordination programs without a strong transitional care component are unlikely to yield net Medicare savings. The study also found programs with substantial in-person contact that target moderate to severe patients can be cost-neutral and improve some aspects of care.
Physician job sharing provides numerous benefits for not only the physicians themselves, but their employers as well.
Carla Peracchia, MD, of the University of Rochester (NY) Medical Center (URMC), is one such physician who chose flexibility over finances. She and Lara Evans, MD, share their practice at URMC and have done so for nearly 10 years. Peracchia notes that, among other benefits, quality of life has been enhanced as a result of the partnership.
She and Peracchia have developed their own physician sharing model, which they agree works quite well. During the week, each works two full days alone and one full day together at the practice. In addition, Peracchia and Evans each work on-call half of the time.
Consider the benefits and drawbacks of the model:
Pros:
Better quality of life: less stress, more time with family
Part-time hours
Collaboration among physicians for better patient care
Flexibility
Ability to serve an increased number of patients at lower overhead costs
Potential to bring in more revenue than can be generated by a single physician
Cons
Higher overhead costs if offering physicians full-time benefits
Mismatch of physicians if one of the providers is more popular than the other
Less income due to part-time hours
Less than equal on-duty hours among the physicians
This article was adapted from one that originally ran in the February 2009 issue ofThe Doctor's Office, a HealthLeaders Media publication.