Chasing the Rabbit: Official Blog by Author Steven Spear

Cutting beds in a crucial emergency department to cut costs is indicative of the flawed thinking that afflicts health care.  Time and resources are currently used at their maximum efficiency and effectiveness.  Therefore, to get more care, we have to spend more.  If we must spend less, we must treat less.  Wrong.  There is overwhelming evidence that better care can be provided to more people at less cost when more sophisticated management approaches are used.

With a souring economy, a prestigious Chicago hospital has proposed cutting beds in its Emergency Department, prompted outrage and resignations of protest by senior leaders  (”Doctors Fight Plan to Limit Beds in ER,” Thomas M. Burton, Wall Street Journal, February 28, 2009).  This debate reflects the same broken thinking that prevents us from achieving lofty goals of health care for all that is high quality and affordable–that to get more we have to pay more and if we can only afford to pay less, we much settle for less.   I’ll hazard to wager whatever pittance is left in my 401K that the over crowding is an artificial and avoidable phenomenon, a direct result of process mismanagement with demand not really exceeding the real capacity of the unit.

My conviction is based on personal experience with a great team at the University of Pittsburgh Medical Center (Shadyside) some years ago.   The ED there was often overcrowded with patients subject to delays in receiving care.  Expanding the facility or contracting care availability were equally unacceptable.  The alternative?  An intense study of process to find out what was causing complications yielded incredible insights.  Despite a conviction that ‘every patient is different,’ it turned out every patient was the same at least in terms of the first ten steps from sign-in through first orders.  

With that realization, those steps were sequenced and responsibility was clearly assigned.  Each step from triage through registrations was studied and restudied to look for possible efficiencies. Where there once was a full registration and a ‘fast’ registration (a partial registration to be completed later), all registrations were cut to three minutes max with time to first orders cut to a stable 18 minutes, a far cry less than the hour standard previously.  

The other benefit? Once first orders were written, most patients could be discharged and which others needed immediate admittance to a medical unit.  The result was quicker care for everyone, and those patients needing additional care or observation received it in a unit that was less crowded, less stressed, and more capable of handling a higher patient load.  

Never forget, whenever we see someone making choices that suggest they are stuck in a ‘trade off’ mindset–to get more we need spend more or we must accept less to spend less, we must demand they look for a third way–process excellence leading to far greater efficiency and far greater effectiveness than they can obviously imagine. 

Related posts:

1. Breaking the Tradeoff Paradigm Among Quality, Safety, and Cost
2. Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All
3. Outcomes Measurement: The Linchpin of Healthcare Reform
4. Krugman concedes main objection: In fact, more care needn’t cost more…
5. Paul Kruman misses the point (again): Better care at less cost is the key…