Thursday, January 15, 2009

An e-patient call to arms

Cross-posted from the e-patient blog

E-patients, this is a call to action. Now. I want you to go express yourself on Paul Levy's blog.

Most readers of health policy blogs know what a costly, inefficient mess healthcare in America has become. Paul Levy would like the people in his business to work together to fix that. Wouldn't that be nice?

Last month he proposed that all the hospitals in the area band together to share information about how to solve problems like hospital-acquired infections. (He's already been posting his own hospital's failure rates on their web site, for people to monitor as they work to improve it.) And on 12/21 he proposed that hospitals not only share data, but work together to figure out how to prevent problems, so you and I don't have as much chance of being harmed during our stay in all their hospitals:

What if all of the hospitals in the Boston metropolitan area -- academic medical centers and community hospitals -- decided as a group to eliminate certain kinds of hospital-acquired infections and other kinds of preventable harm?
And what response has he gotten? NOTHING. From his post today:
Look at the non-response to my challenge to all the Massachusetts hospitals on this matter a few weeks ago. I don't think I am being egotistical to expect at least one hospital administrator or someone from the state hospital association to contact me and say, "Yes, let's try it." Or even have one of them say, "That's a dumb idea." No, the response is silence.
The subject today was the big national news story about how using checklists reduces medical harm. (He has links to it.)

To ordinary citizens it's obvious that checklists make sense, but many doctors are acting like it's some weird controversial idea, or maybe just some fad.

The thing that really irks me is that in the comments, it seems like almost the whole medical establishment is saying "But I don't WANNNA do it different. It's too HAARRRD." Here we have clear evidence that checklists reduce harm, but these intelligent people seem to be whining "But they were mean to us when we were in med school. We LEARNED to hide our mistakes. It's not our fault" or "It's too HARD to change culture."

Well, it's not. Charlie Kenney of Cincinnati Children's (another exemplary hospital) commented about how they've made the change, and he names names of his people who were brave enough to put patients first. (Ya think??)

There is not enough patient voice on that discussion. One other blogger patient besides me, the famous Pregnant Stephanie, said "Bring on the check lists!" And that's where you come in.

Go torch that thread. Set the place on fire, burn it down. Go say what YOU think about whether hospitals should adopt checklists. Tell the doctors and administrators to listen. And ask 'em what the blazes they're talking about when THEY don't put patients first.

Click here to read the post and its comments, and add your voice. And yes, let's get radical: DEMAND that they put patients first. Click here. Really.


  1. e-Patient Dave,

    I am happy to see you and all the bloggers out there picking up on this. What I see is an article that has generated a huge amount of emotion from two polarized groups of people. This is unfortunate because the reality is that we (the medical community at large) DO want to do the right thing. So let me address a few points.

    1. You're commentary that "the whole medical establishment" are whiners is harsh, inflamatory and just plain wrong. The truth is the medical establishment is critical of this paper because it simply isn't hard science. The 50% mortality reduction is subject to scrutiny, and even Dr. Peter Pronovost is skeptical.

    Also see this blog Buckeye Surgeon

    2. "There is not enough patient voice on the discussion." Honestly, I think that there really is a huge patient voice in this, and it is being heard, and that is why we have so much investment in groups like JCAHO, IHI, LeapFrog and the like. This brings us back to why you percieve the above #1 problem (go to #3).

    3. We (the medical community) now are required to document so many things for so many groups in so many differing forms that it is now becoming an insurmountable issue. Honestly, this is a really big problem. I personally can attest to pilot studies of ICU nurses showing them spending 5 minutes documenting for every one minute with their patient. This is unsustainable. So, what you are really hearing is the medical community is concerned with what they percieve to be an increasing documentation burden based on pseudo-science. This is valid criticism. If we are to continue with this pathway (and we will) then we need people to pay for the burden of documentation. (I can give you more on that subject some other time).

    All that being said. I believe in checklists. My group has probably the biggest checklist ever for ICU patients. We continually evolve the checklists in an effort to identify strengths and weaknesses. We promote and practice evidence based medicine utilizing computerized clinical decision support and in fact have published research articles in this area.

    Shoot. This is getting too long. I maybe some other time I can address why Levy isn't getting anyone to come play.


  2. Hi, Joe. Good to see you. Thanks for your contribution. Everything I've seen you post has added something to my understanding.

    I do want to say, I carefully didn't say that the whole medical profession is whining. I personally know otherwise, first-hand. My wording, which was intentional but perhaps not clear enough, was that in the comments it seemed like the whole profession was whining. And already, subsequent comments have made clear that that's no longer true, even within the context of that discussion.

    Re the extent of documentation you're required to do: I suspect you and I would find we're well aligned on that subject, if we dug into it. My focus in the business work I've done has always been to get things out of the way that are getting IN the way, and especially to eliminate senseless uses of valuable resources. Squandering the time of a skilled physician would be an example.

    I know very well that I only know a gnat-sized bit of information about HC. At the same time, I know that people like our buddy Dr. Ted Eytan are eager to apply Toyota-style methods to getting the job done.

    I don't know... lots to learn. But up to the moment when I wrote that post, the comments I'd seen were not encouraging.

    And hey, how COME no other hospital has said a peep in response to Levy's suggestion? Do come back and talk about that someday. :)


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