Healthcare is a very traditional and conservative industry. Never more has this been apparent that after a few seminars I have recently attended on quality in healthcare. After the seminars, two things stood out in my mind: 1. Healthcare is, generally, not willing to take advice from folks “outside” of healthcare; 2. Physicians are the hardest to change.
While healthcare, at this point, is desperately trying to adopt successful manufacturing principles to reform the delivery of care in this country, they are unwilling to allow quality engineers to help them “re-invent the wheel.” What I have been taught, and believe myself, is that a quality expert (from any field) can be successful so long as they build teams of experts from the field. So, in my mind, healthcare professionals need to become more open to the ideas and teachings of quality experts in order to get the wheels of reform rolling. With time, the quality experts will have trained enough healthcare professionals, like myself, to carry the torch and lead healthcare into the next generation of delivery – patient centered healthcare.
Secondly, the hardest group to convince that healthcare is in need of change are the physicians. It seems that when re-designing healthcare facilities, the focus is often centered on the physicians and not the patient. This is because the physicians tend to dig their feet in to what they think is appropriate for the patient, which usually turns out to be not so patient-focused. Further, the physicians are the last ones to admit that they make mistakes. With the legal system being what it is today this is completely understandable. This is perhaps why, the IOM report has been speculated to be underestimated by about 4-fold. However, studies prove that patients are less likely to sue if they are told the truth about the error that occurred during their treatment or procedure than if the truth is covered up. The patient just wants to be told the truth about their care.
In order to completely reform healthcare, we must get physicians on board with the quality movement. Their view that they are infallible needs too be changed, and they must realize that the patient deserves better. Finally, physicians must respect the teams of professionals that help them to treat their patients on a daily basis. Too often, I experience physicians “passing the buck” on to the nursing staff, lab staff, etc. for errors that occurred. Physicians need to realize that these people are the frontline workers, the faces of quality, that are very passionate about the service they provide. The teams of professionals work very hard and take patient care very personally, which is perhaps why the turn over rate for nurses is so high. No one purposely makes a mistake, it’s the current processes that leave the door wide open for an error to occur. Overall, everyone needs to realize that if an error occurs, it is everyone’s responsibility as the system has failed them.
Like Deming and other quality pioneers, everyone in healthcare must realize that it’s the not the people at the center of poor quality, its poor processes that are leading to medical error. Until physicians and healthcare professional, alike, can admit that medical error occurs as a result of processes designed 40 years ago, there will never be any improvement in the delivery of care.
Fortunately, physicians are starting to understand the need to reform the quality of healthcare. Unfortunately, they are just “blips on the map.” In order for the movement to be launched in the physician sector, these blips need to connect the dots and create a contingency of followers that suggest to physicians across the country that the time to adopt new practices is now.