Chasing the Rabbit: Official Blog by Author Steven Spear

Liz Kowalczyk’s article (Hospitals Shorten the Waits in ERs, Boston Globe, December 24, 2008) reveals a deeper truth about health care delivery.  We would get more and much better care at less cost were healthcare delivery managed more sophisticatedly.  Government can prompt this, without more taxing and spending.  

Hospitals were under serving patients by diverting cases elsewhere when emergency departments (EDs) overcrowded.  However, over crowding was not just a demand-capacity imbalance.  There were avoidable delays, inefficiencies, and disconnects in the EDs and other departments.  Investing time (not only money) in smoothing flows and coordinating efforts generated ‘free’ capacity.  The key?  Performance had to be measured, with hospitals held accountable for bad performance.  This unlocked creativity and innovation directed to the betterment of care. 

The same is true across the board, not just with emergency medicine.  As documented in my book, Chasing the Rabbit, and as is proven by the Institute for Healthcare Improvements 100 Thousand Lives Saved and 5 Million Lives Protected from Harm campaigns, providers can eliminate persistent afflictions such as ventilator associated pneumonia, surgical site infections, and patient falls by managing care delivery in other than a haphazard fashion, thereby unlocking previously squandered resources for better access across the range of preventative, primary, chronic, and acute care.  Demanding an end to diversions is a first step as is Medicare/Medicaid’s refusal to pay for ‘never events’—harm done while a patient is being treated.  Next are better measures for more services, and increased circumspection by payers and patients based on those.

Related posts:

1. Krugman concedes main objection: In fact, more care needn’t cost more…
2. Spear on Bloomberg: What’s health care reform missing? Quality!
3. Spend more to get more? Not necessarily in health care
4. Errors and Openness at Beth Israel Deaconess
5. Paul Kruman misses the point (again): Better care at less cost is the key…