Feb 11, 2007

What I would do now if I had my impossible dream

This post is an answer to Paul Levy's invitation to throw out ideas about what can be done to improve safety and quality in hospitals.

Maybe 10 years ago I attended a course in implementing the quality standards ISO 9000. It was a big surprise to me that the course did not seem to teach us methodologies, forms, etc., but was more about finding common sense solutions to enterprise functioning. The most important idea that I learned and kept haunting me ever since that course was: ask the people that do the work to tell you how can their work be easier, how can things work better: they know, just listen to them. It's that simple.

So my answer to Paul is that I have no clue what can they do better, but I know who does: their patients, nurses, doctors and other staff. If someone digs into this collective knowledge and interprets it intelligently, you can find out what you need to do.

I would send a smart analyst (no need of medical knowledge) in the trenches and talk to the patients in the waiting room: ask them what should be changed, what is good, what is bad. Ask the inpatients, ask the nurses, ask the doctors. Don't send a kid with a prewritten questionnaire or survey, the person that does this needs to know what question comes next, needs to know how to interpret the findings. The analyst needs to bought by what he's doing: understand it's importance and believe that he can make a difference.

I would first screen the people I interview by selecting the ones that are good patients, are literate, and that can give reliable feedback.

If you care about patient safety, I would send someone to gently talk to persons that had something bad happen to them. Talk to them even years after the fact. There are some of us that keep searching for answers and would know exactly what doctor/nurse did what mistake and how it can be avoided in the future. They would tell you what hurt them and what helped them heal.

The other day I was reading a pharmacist blog. He was complaining about the old patient that was yelling at him about a problem with the voicemail system. I could understand how he just wanted to do his job - fill in prescriptions. And I felt guilty for all the silly little things, non-medical related that I was telling the nurses and doctors... they don't care about these things, they shouldn't care about these things, but there is nobody else that I see that cares... If I tell the receptionist, she is trained to be nice to me and mind her own business.

Maybe I am a dreamer, but in my ideal world I see an office manager being in the waiting room a lot asking what can be done to improve the patients experience. I think this non-medical oriented person that is empowered to resolve issues that she finds can ease both the patients lives and allow the nurses and doctors to do their job.

There are a lot of patient satisfaction surveys these days... I never found out that I can really give a good feedback in the rigid structure or that my comments had a positive effect on the institution. I personally was seen by more senior doctors and I was treated better because I complained, but that was it. Pretty much like what Paul is describing: if the board only sees green the Board is bored and loses interest. If the only survey result is that we are treating the most critical respondents better, it doesn't make us better overall.

And my conclusion with a sigh: oh, how I'd love to be that analyst!

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