Elevators and Amusement Rides
Yesterday was no different than many other days in my life as a consultant. Two clients, three cities, and finally arriving late evening at the hotel. It had been a long day of travel and I was looking forward to getting into my room and off of my feet. As I got onto the elevator, for some reason, the inspection certificate caught my eye and I felt compelled to read it. Capacity 1750 lbs. No more than 5 passengers. Inspection good through January 2012. And then I saw it – Certified by the State Administrator for Elevators and Amusement Rides. Elevators AND Amusement Rides? Did I miss the “You must be THIS tall to ride this ride” sign? Visions of “approved” rusty carnival rides whirling in the air made me very glad to step out of the elevator and onto something a bit more structurally sound.
This week a new study from Mayo Clinic was released, outlining the volume of colonoscopies a physician must perform to demonstrate expertise as rated by an objective test of endoscopic skill. The study showed that the number of procedures needed to show competence in colonoscopy was nearly double the 140 procedures currently recommended. It also raised questions regarding many procedures and the training required to attain true expertise in performing them.
As we continue to plunge into a world of healthcare accountability based on value and not solely on volume, I have to ask the question: are setting the quality bar high enough? It is a difficult discussion for many practices and health systems to have, but the question of clinical competence must be expanded beyond performance that is simply ”greater than the state or national average.” Have we given our nurses and clinical staff the appropriate training to truly excel in caring for our patients? Are we holding all physicians to the same high standards for every procedure, in every setting? Have we allocated our financial resources to truly focus on the highest clinical outcomes attainable, not just performing better than our nearest competitor?
As the concept of measuring value and holding each other accountable for outcomes evolves, we must be cautious not to measure only what we currently can track and assume that it is good enough. We must continue to push to measure that which truly demonstrates a standard of excellence, not just a standard of competence, even if that means that some physicians or health systems won’t be able to provide that service until they can demonstrate a higher level of care. It may be difficult, but until we in healthcare hold ourselves to these new, higher standards, we will never know if we are getting elevator or amusement ride quality.
Quality outcomes that matter are defined by patients in consultation with their personal physician. Setting the bar higher requires more emphasis on communication skills for non-primary care physicians and administrators. (The PC docs get tons of IPS and behavioral training and feedback in Family Medicine training.)
Knowledge of how to get business people away from healthcare would be another quality move for physicians. The word quality in the current use in the Medical Industrial Complex sounds like a cash register ringing, not the "Thank You" of a satisfied patient.
p.s. Take a day off and go to an amusement park. You'll be pleased at the sturdiness of the rides.
Right on target Mark!
This will be a massive culture shift for providers who will need to not just sit through CME but may have to show comprehension via testing and competence through execution.
On the other hand I believe that these same standards need to be applied to consumers/patients who are clearly (on average) not able to manage their own health. Accountability has to be taken by all stakeholders for in order to improve health outcomes before we go bankrupt. So are you ready to be accountable for you Healthy Behaviors (which account for 51% of our health status)? After all Providers can only suggest the best path - each of us has to take it! We will need to develop a life long continuous personalized health & wellness curriculum approach to educating ourselves. Are your ready for your personal health & wellness score which, like your credit score, will measure your health behaviors and influence your cost?
This would only seem fair to me if I was a Provider...
Quality over quantity. I definitely agree with Mark. We all need to plunge into a world of healthcare accountability based on value and not solely on volume. Setting the bar higher requires more emphasis on communication skills, as A P Jonas mentioned, and much better training to truly succeed in caring for our patients; as well as create a standard of excellence amongst nurses, clinical staff and every person involved in the health system.