Question: How Can Hospitals Maintain Efficiency While Looking Out for the Needs of Their Patients?

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PTD-thumb1Consider the following true story: Mr. Jones has been regularly receiving treatments for his cancer, all of which have been successful so far. During a routine follow-up visit, the attending physician, Dr. Smith, follows normal procedure and allows a fourth-year medical student, Joe, to examine Mr. Jones.

However, Dr. Smith becomes concerned when the visit exceeds the expected 15 to 20 minutes.

Quietly slipping into the room, he discovers the patient is in tears. Apparently, Joe had been asked a question by Mr. Jones that seemed to have deeper implications. Upon further inquiry, Mr. Jones revealed to Joe that he was having suicidal tendencies and had made a vain attempt at medication overdose one month earlier. He was even contemplating breaking the law in a way that would force the police to take his life.

The physician and medical student quickly determine the patient is in need of additional care beyond his cancer treatments. He will require hospitalization and an emergency psychiatric consultation.

The way the visit ends is far different from how the visit began as a routine cancer follow-up appointment.

We often say the style of care that was seen in classic physician TV series like Marcus Welby, M.D., and Dr. Kildare, where the physician often had heart-to-heart, deeply personal interactions with patients, is a thing of the past, if not an outright fantasy for the future.

After all, efficiency is King. The metrics must be met. Patient volume must be managed and contained. Get ‘em in, get ‘em out, keep things moving, keep the flow steady.

Our story, however, recounted by Richard Gunderman, James Lynch, and Heather Harrell in a recent article from The Atlantic, reminds us of the potential pitfalls present in the current metrics-oriented healthcare culture being created and developed.

As the article candidly points out, “From the point of view of efficiency, Mr. Jones’ case represented a glaring failure. A routine cancer follow-up visit that should have required less than 20 minutes ended up consuming hours. Other patients were inconvenienced, and their customer satisfaction survey results probably reflected poorly on both Dr. Smith and the hospital.

“In a highly efficient medical practice, there might be no opportunity for such an interaction. The physician would be in too much of a hurry to address Mr. Jones’ medication question. Instead he would simply congratulate him on his normal laboratory results and CT scan, pat him on the back, and send him on his way. He would complete all the required sections of the electronic visit record, maintaining his high quality and patient throughput metrics.”

They ominously conclude, “Had mandates concerning efficiency and productivity been foremost in the minds of Joe and Dr. Smith, Mr. Jones might well have died.”

Of course, this death wouldn’t “have counted against the medical team,” since Mr. Jones was there for a routine cancer follow-up, not an emergency psychiatric consultation. “So as long as they checked off all the boxes on the electronic cancer follow-up form and got the patient in and out of the examination room in a sufficiently short period of time, they would be judged winners and rewarded accordingly.”

This is an ongoing conundrum not just for physicians, but also for healthcare executives, whose careers are often dependent on measurable, not anecdotal, success.

So, is there a middle ground between the efficiency that often leads to more superficial physician-patient interactions?

Put another way, how can organizations focus not just on efficiency, which is important, but also on getting to know their patients in a way that helps physicians discover their less-than-obvious needs?

As healthcare executives, how can you facilitate this balance, while satisfying federal metrics and consumer demands?

-by Pete Fernbaugh

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