Chasing the Rabbit: Official Blog by Author Steven Spear

Laura Landro, writing the “Informed Patient” column at the Wall Street Journal, explains that  hospitals are admitting when a patient is grievously harmed. (”Hospitals Owning Up to Errors,” Wall Street Journal, August 25, 2009).  This is good news, but if it ends there, greater opportunities are lost.

Complications occur with staggering frequency.  Very few hospitals identify and investigate small as well as large ones immediately–not on a delay, to find the root causes of inefficiency and ineffectiveness that compromise affordability and quality.  Some have achieved near perfection in eliminating patient harm as an occurrence.

Until all hospitals do the same to improve, public transparency about ill events–large and small–should be required.  Now, patients largely source care blindly, inadvertently trusting institutions too often that are dangerous and too infrequently to those that are remarkably safe.  With informed choice, average quality would be driven higher and average cost progressively lower.

How do you make money making soda cans? The  imperative once may have been to lock up raw-materials, hoard critical technology, and tie-up customers. Then, reap rewards.  Today? Someone is competing with you for supplies, your technology is not proprietary for long, and you constantly being challenged for your customers’ attention.  The result, return on assets being cut by three quarters since the 60s.  The only response?  A radical change in leadership style, one in which you are constantly innovating–discovering ever better solutions to the challenges of the market, and teaching others how to innovate too, so you capacity is broad based and tireless.  Read more in “Leadership and Innovation in a Commodotized World,” at HarvardBusiness.Org.

Gawande, Berwick, Fisher, and McCellen (”10 Steps to Better Health Care,” NYTimes, August 13, 2009) document what many of us already felt: For the same service some health care organizations deliver great care affordably while others provide compromised care that is still costly.  If we all got care from the best, they suggest, there would be no crisis.

The irrefutable conclusion is that with such range in quality and cost, you have a right to know who will help you and who will cause you harm.  In service to that right, the necessary policy is clear: Mandatory reporting–first of avoidable complications like medication error and falls, building to ever better measures about efficiency and effectiveness.  With reliable information, you can choose wisely, and every informed choice will raise quality, reduce cost, and keep bureaucrats from having to make our decisions for us.

When my daughter was hurt, I picked a hospital knowing there was a 24 hour coffee shop opened that night.  Am I so reckless?  Hardly.  The problem is, finding out where the care is great and where it is poor is wickedly hard.  Not knowing matters.  If you want evidence, check out the great Hearst Newspapers report by Cathleen Crowley and Eric Nadler, “Dead by Mistake.”  Patients at ‘name brand’ hospitals, one who drowned in his own blood, another with a feeding tube stuck in his lung, another who got a lethal cocktail of pain killers and sedatives.  And this is ten years after the Institute of Medicine’s To Err is Human warned people of the horrific risk to patients.