Improving health care quality

As the founder of an important and perhaps the first online patient satisfaction feedback Web site (and the only one I know of that doctors encourage their patients to visit), I am a huge believer in the importance of enhancing the quality of American medical care.

My focus is on helping doctors give patients care that patients perceive is terrific.  Many other people — determined physicians, dedicated scientists — are working to improve the  technical aspects of care, particularly by developing and incorporating measures of quality and by reducing the number of preventable adverse events.

Dr. David Nash, Dean of the School of Population Health and the Thomas Jefferson University, is an expert in this rapidly advancing field.  I talked to him yesterday on the Getting Better Health Care radio program.  You can listen to the program or download the podcast here.

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Straightforward advice on reducing malpractice claims

The American Medical Association issued a report on malpractice claims .

The report found that over the course of a career, most physicians will have been sued at least once.  Given how many patients a doctor sees over a career, the frequency of malpractice claims is very low.

There are a few straightforward things that doctors and patients can do to reduce the risk of a malpractice suit:

• Doctors should give patients technically sound care.
• Doctors should provide care  in a caring environment. Obtaining  feedback from patients on their perceptions of their care helps in this task.
• Patients should make sure they get copies of any laboratory or pathology work that is done.  That will help assure that nothing falls through the cracks.

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Superfreakonomics

Just finished reading Dubner and Levitt’s book Superfreakonomics. It is an entertaining follow-up to their most excellent first book, Freakonomics. Among the eclectic topics in Superfreakonomics is their work on the quality of emergency room (ER) doctors —finding that the likelihood of surviving a trip to the ER depends less on which doctor a patient sees and far more on other factors including patient demographics and condition.

The great majority of patients survive the ER. Dubner and Levitt report that estimates of doctor quality suggest that the quality of the doctor might affect the low death rates by 10 percent. On the positive side, 10 percent of an already very small number is a small effect indeed, so that even average doctors are doing a very good job. On the “glass is half empty” side, over the thousands of patients seen each year in the ER, the difference in quality will end up in a few lives lost, and each one is significant.

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More from Why Hospitals Should Fly

Another of the highlights of Nance’s book Why Hospitals Should Fly involves the importance of unambiguous communication and the need to seek clarity from others. The line that really caught my attention was, “I know you think you understand what you thought I said, but I’m not sure if you realize that what you heard wasn’t what I meant?”

All too often, in medicine and in life, miscommunications occur. When we say something, it comes from the context in which we are currently thinking. The receiver of the message may interpret the words in some completely different context. This can result in dramatic degrees of miscommunication between health care professionals and between physicians and their patients. These kinds of miscommunications are one element discussed in my book, Compartments: How the Brightest, Best Trained, and Most Caring People Can Make Judgments That are Completely and Utterly Wrong (www.compartmentsbook.com).

Nance points out that we should listen to people repeat back what they said to us. That’s one helpful approach. Having a buddy come with the patient to record key points is another. Written instructions may be the most valuable way to assure good communication between doctors and patients.

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Why Hospitals Should Fly

John-Henry Pfifferling, director of the Center for Professional Well-Being, said I had to read John Nance’s book Why Hospitals Should Fly: The ultimate flight plan to patient safety and quality care (John J Nance, JD, Second River Healthcare Press, Bozeman, MT, 2008). It’s a wonderful book about the need to improve the safety of health care. The incredible safety record of the airline industry is something our medical system can learn from.

One of the highlights of the book referred to video documentation of operating room procedures. The point was, like the airline uses “black boxes” in cockpits, to review the video and identify possible areas for improvement. If any problem occurred, it is even more important to review and learn from the tapes.

Nance predicts one concern about the tapes: how they might be used against the medical system. Nance’s protagonist responds, “What are we doing [in the OR] that we want to hide?”

This is one of the fundamental principles of doctor rating on DrScore.com. Some people ask, “Won’t doctors hate this?” My response is that doctors have nothing to hide when it comes to patient satisfaction. Doctors want to give patients great medical care, and doctors do so day in and day out. Nothing could be better for doctors than for the public to know how happy most patients are with their doctors.

That’s not to say that doctors can’t do an even better job. Of course they can, and they strive to do so. Patient feedback from online doctor rating gives doctors the assessment tool they need so they know where they stand and where they need to direct further effort. While positive feedback is always welcome, feedback that identifies things that can be improved is a special gift.

Patient safety is a critical issue and one for which Why Hospitals Should Fly offers some valuable insight. However, Nance’s book isn’t about how medical care needs to be more like airlines when it comes to customer service. While I’m sure we can learn something from every industry, I’m not sure the airline industry is the best model of customer service to emulate!

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