Quality in Healthcare, Patient Wait Times, & MD Arrogance

Physicians believe that:

Anyone who delivers care in less time than me must be cutting corners and providing low quality care. Same goes for clinics, hospitals, emergency departments…

Do physicians believe, then, that taking longer would improve quality? Does more time equal more quality?

Deep down, many physicians believe that:

The highest quality care happens at precisely the speed at which I provide it, or could provide it, if I chose to work at my top speed.

This could just be physicians resisting change for their own reasons. But I think there’s more…

Outcomes & Quality in Healthcare

Patients believe compassion equals quality, and rightly so: quality care must be compassionate.

But patients also want great outcomes.

Time determines outcome for most EM care (ICES Quality Report, 22 of 48 indicators are time based).

Many papers show ways to decrease waste for patients: see articles on LEAN and time in emergency care.

EM associations teach ways to increase speed without decreasing quality (Physician Efficiency, Canadian Journal of Emergency Medicine; Doing Things Faster Without Sacrificing Quality, ACEP), and many report ways to speed up care (Speed it up from Stanford 2013; ERs Move to Speed Care, WSJ 2011).

Time equals quality in emergency care. There is no evidence that patient waiting or taking-a-long-time-to-provide-care equals quality.

Humility can help to improve performance. Are we willing to look for ways to improve based on others’ success?

Physicians Limit Freedom?

A group of doctors discussed gambling.

“You’d never believe the pain some of my patients experience with problem gambling,” one said.

“We should lobby government to stop using revenues from gambling!” said another.

Some listeners nodded.

“Don’t we finance hospitals with lotteries?”

Silence.

“Should physicians dictate morality?” someone asked.

Doctors Limit Freedom?

Regardless of the morality of gambling and casinos, should physicians advocate for laws that limit patient freedom? What is the role of freedom in health and human flourishing?

A physician leader frowned at my defence of patient freedom.

“When do we stop making laws and start supporting individual freedom?” I asked.

“Don’t you agree with seat belts?” he asked. “How about stop signs?”

“Of course I agree with seat belts and stop signs,” I said.

“Well, then you agree with government limiting free choice!”

Now there’s the rub: how much freedom do we give up to live together in a ‘free’ society?

People who conflate stop signs with prohibition confuse mutual limits on individual freedom with imposing personal preference on others.

It’s one thing for us to obey stop signs for the safety of all. It’s something else entirely for intelligentsia to impose restrictions on other people’s behaviour that have little to do with their own freedom.

What do you think? Where do we draw the line between promoting healthy ideas and limiting individual freedom? Who should decide? Do we need more health related laws or do we have too many already?

Want To Hear From A Governance Expert? Pearls

Glen Tecker, a governance consultant, spoke recently. Here’s what stood out:

People want to understand why leadership acts:

What is perceived, is.

Perceptions rest on available information, accurate or not.

In the absence of information, we assume.

Behaviour, no matter how crazy, has a logical basis.

People have little idea about what they need, but strong opinions about what they want. So ask: find out what people want. Communicate how you used those wants to add value and inform decisions. Focus on outcome; describe success. Often, people only find out what they believe is important by being asked.

People engage when things:

Matter to them

Make a difference for them

Are enjoyable for them.

You need all 3 to function:

Authority
Process
Capacity

Without these, you will be dysfunctional.

Re: Big vs. Small organizational groups:

Big Groups serve representative, political functions: they govern a whole profession.
Small Groups serve corporate deliverables: they govern an organization as an enterprise.

Big groups discuss and produce information that small groups use to decide.

Culture of trust needs:

Clarity and consciousness about what will equal success.
Open access to common information.
Confidence in the competence of your partners.

‘Voice’ differs from ‘vote’. The majority must know the concerns and objections of the minority voice. All views need a voice but not always a vote.