Health care in the United States faces significant challenges as we create a new culture that assures we can meet the needs of those we serve with predictable high quality and safety. Culture can be defined as what is going on around you. Let’s look at what is going on in hospitals that is creating a new culture.
As with all sectors of the economy, health care organizations create value for those we serve by using our infrastructure to create goods and services (mostly services) that satisfy the needs of those we serve. Hospitals serve patients, communities, payers (governmental and private), physicians, and our own employees as the major groups. We exchange the value we create for the value these groups are willing to contribute in the form of fees and contractual payments.
Things get a little complicated with third parties paying the bills—indigent care, charity care, inadequate governmental reimbursement, etc. Still the basic equation is the same.
Infrastructure can be thought of as three components: people (with knowledge and skills), systems (computer systems, machines, buildings) and standard operating procedures. Major change is occurring in all three. In the people category, we are creating new skill sets for doctors, nurses, administrators, and all of our employees that will allow them to be better connected to those we serve and better able to understand how well we are meeting their needs.
The skill sets include the use of evidence-based medicine guidelines, the application of process engineering and statistical process control, the increased use of safety engineering and tools like Six Sigma Process Improvement.
We are making massive investments in systems. Many hospitals are spending millions replacing computer systems to support this new culture. Safety design principles are being applied to the design of new buildings and processes with the aim of improving workflow. These tools will allow knowledge workers and caregivers to spend more time at the bedside doing the caregiving that makes their jobs meaningful and worthwhile to them. Patients will realize new security in freedom from errors and will feel better cared for, with new opportunities for participating in decision making and getting their questions answered. Physicians will be better able to make decisions at the point of care, with easy access to patient data and the best evidence available in the world’s medical literature.
New standard operating procedures will define the way we do our work. Single registration processes that introduce patients to a seamless delivery system, routine application of outcomes monitoring system, elaborate fail safe mechanisms for assuring medication safety, and effective standardized ways of assessing and managing pain are examples of standard operating procedures already in process in many hospitals across the country. Perhaps one of the strongest of these is the enlistment of patients and their families in the process of enhancing safety in our hospitals.
These are exciting times in health care. We can create a new culture. The process is well under way. IBI