Baker's Decalogue for high-performance healthcare organizations

Jordi Varela
Editor

 

Americans trust that competitiveness is the essence of human activity, which has made them the world's leading power, with China's permission. This principle, however, has not worked for them when they have applied it, without palliative, to their health care system, which is showing clear signs of poor performance: it’s very costly, it’s inequitable and it’s showing poor results. For this reason, some public health care organizations such as Veterans Affairs and Medicare, or private, such as Mayo Clinic, Cleveland Clinic or Kaiser Permanente, are trying to put sanity, analyzing what are the keys to improve the performance of the system.

Saving Plans: 5 Errors and 5 Proposals

Remember the games of the analogue times, precisely the moment when the player put the piece in the wrong place and there came a warning sound and the red light lit up the nose? Now it looks like a naff old thing, but I liked that Robert Kaplan and Derek Haas have chosen the image of one of these games, precisely one that is for operating a patient and that they have chosen it to illustrate their article published in the Harvard Business Review blog, "How not to cut health care costs".

When faced with budget cuts, they say, health managers around the world apply the same recipe: reducing staff costs (both in numbers and in wages), optimize the use of space to save general services, stop investments and rationalize spending. The authors do not maintain that this package of measures is poorly done, but they question whether behind these policies there isn’t a strategic way of thinking that combines resources to achieve the best results in the most efficient manner possible and the efforts of the basic savings pack can become counterproductive for the health of people and also for the economy of organizations.

Therefore, we should appreciate that the article analyzes five errors of the basic savings pack, while proposing five alternatives focused on efficiency and effectiveness.

Clinical safety: "The Leapfrog Group" and other benchmarkings

The Hospital Safety Score is a scaled assessment (A / B / C / D / E / F) of American hospitals that aims to provide that insurers and citizens have access to proven clinical safety information offered by each hospital in the system. The Hospital Safety Score is a summary of 26 parameters that feed on both a voluntary survey and official sources: AHRQ (Agency for Healthcare Research and Quality), CDC (Centre for Disease Control and Prevention), CMS (Centres for Medicare and Medicaid Services) and "American Hospital Association Annual Survey."

Hospital Benchmarking: Top 20 Iasist and "US News Best Hospitals"

Benchmarking is a healthy exercise but to do it in the healthcare field it’s necessary to have solid databases, to know how to select consistent indicators and how to adjust and refine the data to the maximum so that the results are really comparable. In this post I want to discuss the essence of two famous private competitions, one Spanish and one North American.

Iasist, a company specializing in health information management has announced the 15th edition of the Top 20, a competition amongst Spanish hospitals which is voluntary, free and anonymous where only the results of the nominees and the winners are published. The purpose of this competition is in the winners’ institutional prestige.

Four ways to make Sutton’s law a reality

It occurs to me that there are four possible approaches to address Sutton's law (remember that this law tells us that we have to go after the waste to raise funds for activities that really provide a health value to people, see post March 28th) and I think we need the four approaches at once:

1. Medical service based on patient preference (see post February 27th)

There is a report from a Cochrane review that says that when patients have contrasting information, other than from their doctor, they have a tendency to choose more conservative therapies within the range that is offered with their diagnosis. And, according to some researchers, up to a 20% reduction in some scheduled surgical procedures can be expected with this method.

2. The role of scientific associations in addressing evidence-based medicine

The difficulties in the practice of medicine begin in the gap that exists between the scientific evidence and the reality of clinical practice. In this area there is a missing link that causes a striking variability in clinical practice and the utilization of health care resources. For this reason, in recent times interesting professional initiatives are being observed (which we will discuss further in later posts), of which highlight "Do not do" from NICE in the UK and "Choosing Wisely” from ABIM Foundation in USA.

Wennberg: ten thoughts about chronic care

In Chapter 12 of his book "Tracking Medicine", John Wennberg reflects on how the American health system is treating chronic patients and, as I think it is a careful and timely analysis, I want to dedicate this post to comment these reflections.


First thought

Blind trust in hospital medicine does not work for the chronically ill patients

It is considered that Medicare spends 18% of its budget on hospital admission bills during the last two years of life of chronic patients. While it is true that overactive hospitals can add some days to the lives of chronic patients, the question is what is the quality and how big is the suffering... and at what cost.

Second thought

Sutton's law: If you are interested in saving money, have no doubt that the saving is to be found in hospitals

Willie Sutton was a bank robber, and when asked why he did it, he answered: "That's where the money is, right?". Wennberg proposes a strategy for implementing Sutton’s law in a less bleeding way: benchmarking. I mean, if you get the hospitals that admit more chronic patients to reduce these rates to levels of those hospitals who admit less, you could raise enough money for community programs more tailored to the needs of these patients, and also could really make a saving.