“Our team must contact the patient’s family physician during the admission, inform him or her of the situation and plan for appropriate patient follow up after discharge.”
If you talk to any hospital physician or family doctor, they would almost certainly agree that this type of integration between hospital and community is essential for reducing avoidable ER visits, readmissions and improving other key health outcomes. Put more simply, it’s just good care.
And so you would think contacting a patient’s family doctor during a hospital admission would be the standard of care – but it’s not. There’s no rule or expectation; rather, it’s just something nice to do.
I’m not here to criticize health care providers who do or don’t act a certain way. I’m sure there are many best practices which some providers do that others don’t, and vice versa.
That said, I don’t think we can deny the harsh truth: It’s no longer about knowing what needs to be done to provide higher quality of care at a lower cost. We know enough answers to begin implementing.
The more important question is: why aren’t we doing so?
You can’t improve what you don’t measure
There are three necessary requirements for improvement in health care:
- There must be metrics by which you can measure improvement.
- The results of these metrics must be delivered back to providers.
- Providers must be motivated to change.
In our health care system, I think we often delude ourselves into thinking we do all 3, when realistically we only do #1.
Readmission rates, ER visits, length of stay, etc: we have developed an abundance of actionable metrics that we can use to improve our health care system. Of course, many experts find some of these metrics controversial (for valid reasons), but I’d much rather test these metrics, learn and improve them than do nothing but argue while patient care suffers.
Most hospitals are mandated to publicly report these metrics. Is this “feedback” good enough to drive change? I don’t think so. Why would any individual or team of providers be motivated to improve if they don’t even know how they are doing?
Feedback has to be delivered right to the frontline providers in order to drive change. Showing that a hospital as a whole is succeeding or failing at a certain metric won’t do anything.
Having a department head say “hey guys, our metrics are bad, let’s all try to do better, OK?” won’t drive improvement. It’s just easier for frontline providers to believe it’s someone else delivering suboptimal care. Not holding providers accountable makes that even easier.
However, numbers don’t lie.
An average 30 day readmission rate of 20% across a hospital doesn’t tell us anything about how Dr. A’s team has a readmission rate of 10% but Dr. B’s is 30%. Given equivalent populations, clearly Dr. B has room to improve, because we know a readmission rate of 10% is possible.
On top of that, if Dr. B’s team themselves see they have room to improve, they not only have greater motivation to improve, they can now measure improvement and identify strategies that objectively lead to better outcomes.
Of course, it is more complicated than that, and we have to ensure providers are operating within a framework that deters “gaming” of the system. For instance, if we only measured readmission rates, then you could choose to never discharge a patient and your readmission rate would be 0%.
In any case, my point is that the metrics we currently collect have limited utility because 1.) we don’t collect metrics at the frontline provider level and 2.) we don’t feed this data back.
I honestly believe most health care providers want to deliver better care – but we won’t know what better is unless we can measure it.
Is feeding back data enough?
I wish I could believe that simply delivering health outcomes data back to providers would be enough motivation to drive improvement. While this is the case for some providers, it would be naive to think it true for all of us. We are all human after all.
We need to make it easier for providers to do the right thing. Take engaging the family doctor during a patient’s admission, for example. How could we motivate providers to do that?
One option is to make it mandatory. The problem with this option is that it will likely create disgruntled providers, and you can only make so many actions “mandatory” before everyone turns on you.
The second option, which I prefer more, is to not tell providers what to do. Instead, we feed back the metrics, and hold providers accountable in some way. We find incentives to drive improved patient and system outcomes, but we don’t tell providers how to do it. Providers will naturally experiment with strategies until they find those that optimize outcomes.
The fact that we underutilize actionable metrics in health care is striking and scary. That the health care system is complex is no longer an excuse – we can’t afford to keep making that excuse.
Can feeding health outcomes data right back to the frontline actually work? I don’t know, but someone needs to try it.
Joshua Liu is the CEO of Seamless Mobile Health and a physician specializing in hospital readmissions. He is a 2012 graduate of the University of Toronoto Medical School.