But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Saturday, February 17, 2007

Who do you think you are, anyway?

For those of you not on the inside of the health care system, here is the scuttlebutt around Boston. Some of my colleagues out there are saying to one another, "Who does he think he is, a non-MD, posting clinical information?" "Why is he so far out front on this issue?" "Doesn't he know that these blog postings are bad for academic medicine?" "This is all being done just to make his competitors look bad."

Here is my view. First, let me address the last point. I plead guilty to being highly competitive, but I took over a hospital that was almost driven out of business, both by bad internal management and by aggressive actions taken by other hospitals in town. I think the people at BIDMC -- and I mean everybody -- doctors, nurses, techs, housekeepers, transporters, and food service workers -- have something important to offer the community. I dearly want our place to thrive so they can deliver on that promise, and I will look for a competitive advantage where I can find it.

John McDonough, on the Health Care for All blog, has suggested that high quality care can be a competitive advantage. Maybe, maybe not. I do know, however, that some other hospitals in town can ride on their reputation, rather than on their comparative performance. I also know that some other hospitals in town are reimbursed by insurers based on market share, rather than on quality of care. If people are given accurate data on quality and safety, and if these perceptions and patterns shift as a result of that transparency, so be it.

But I believe that the more important issue for all of us running hospitals, and especially academic medical centers, is that our standing as institutions in American society is in jeopardy. In many respects, people do not trust that we are there to serve them carefully and efficiently. Some think, too, that we do not have proper respect and concern for our workers. Some also think that we do not have sufficient involvement in the community. Here in Boston, the hospitals are now the largest corporations in the city, in terms of staffing, revenues, physical facilities, purchasing, energy use, and the like. By virtue of that standing, we are now expected to meet a higher public standard than has ever been the case.

I know that the people at BIDMC are trying to meet that higher standard. We may falter, and we will make mistakes (sometimes really bad ones), but we are setting ourselves to carry forth the legacy of our two antecedent institutions, the New England Deaconess Hospital and the Beth Israel Hospital.

The description of the Deaconess -- "where science and kindliness unite in combating disease" -- was also the watchword for Beth Israel. Fortunately, the combined institution that resulted from the merger ten years ago maintains that set of values. BIDMC stands as a place where patients know they will be treated with warmth, friendliness, respect, and dignity. We do our best to treat each person as we would want a member of our own family to be treated. This is not just a saying: It is part of the culture of the place, and we deliver on that promise every day and night in the great majority of cases. We aim to continue to show our patients that level of caring and respect.

But this has to be combined with excellence in the delivery of patient care -- and particularly minimizing the probability of causing harm to patients. Clinical quality emanates from the judgment and experience and skills of world-class doctors working with world-class associates like nurses and technicians. But even that expertise sometimes needs help and new management approaches to overcome systemic problems in the organization. As I have tried to reflect in the postings below, we have aspirations to be as good as we can possibly be in that arena. We believe that public disclosure of our progress is one tool in reaching those aspirations.

I hope you agree that more widespread disclosure by all the Boston hospitals would enhance the performance of us all and would build public confidence in the great academic medical centers in our community. I like to think that we will eventually live up to the expectations set forth so clearly by Patient Dave in his heartrending comment on the posting below:

NOBODY has more right to that information than the patient in need. NOBODY.

This is REALLY personal, believe me. If we can easily get info on the best used cars (hardly a matter of life and death), we certainly ought to have free access to information on who has high and low outcomes and accident rates.

We owe it to ourselves and the community to make sure Dave and all other patients get what they need.

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