globeandmail.com: Private sector health care: Think quality, regulation
I don’t think healthcare and quality is a “Private vs. Public” debate. As we’ll inevitably have debate during the 2008 U.S. Presidential election, I think it’s important to keep quality in mind (not just cost and access). Side note, electing a President sure is a “long lead time” process, we’ve already started the process here in early 2007.
In Canada, they have a single-payer government healthcare system. Canada is suffering from the same types of medical mistakes and patient deaths that are commonplace here in the U.S.
Canadian Institute for Health Information (CIHI) statistics show that as many as 24,000 people die each year from avoidable events like surgical errors, wrong medications and hospital-acquired infections.
These types of estimates are often questioned. The number thrown around for the U.S. is 98,000 avoidable patient deaths (Institute of Medicine’s “To Err is Human” report). Assuming the Canada numbers are accurate, keep in mind that Canada’s population is about 1/9th that of the U.S. So, either the per-capita avoidable death rate is worse or it’s roughly the same scale.
Glossing over the details of “unknowable numbers,” I think it’s fair to assume that we have the same results from the very different systems in the U.S. and Canada. We shouldn’t necessarily expect that a shift from one to the other would help, right?
The Canadian columnist I’ve linked to makes her case about standard work and quality:
A recent Auditor General’s report estimated that one of every nine patients admitted to a Canadian hospital will become infected. Listening to hospital administrators doesn’t exactly inspire hope. A televised response from the head of a Montreal hospital where patients died due to a particularly nasty C. difficile outbreak stated that he would “try harder” to get doctors and nurses to wash their hands between patients. And a B.C. regional health authority recently spent $130,000 on a campaign to “remind” staff about the importance of hand washing.Try? Remind? If you were running an airline would you “try” to get the ground crew to properly service the aircraft, or “remind” the pilots to go through the final checklist just before they pushed the throttles forward? Of course not. You would require adherence to standardized safety procedures on a zero-tolerance basis.
The biggest difference is that pilots are employed by the airline, while doctors, in the U.S., are usually not employed by the hospital. I’m not sure if that’s the case in Canada (does anyone know? please comment).
My question: Not that we want to lead with “firing people” as the first step, but has there ever been a case of a doctor getting fired or losing their privileges for bad hygiene?
David Mann had some good thoughts on standard work and hygiene recently.
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.
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{ 2 comments… read them below or add one }
Not a Doctor but in the last month a Dentist was terminated by the General Dental Council for urinating in a sink and using dental instruments for cleaning his ears.
Its on the BBC site.
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Sometimes licensed professionals in the U.S. are “disciplined” for very unfair reasons, and there is a lack of due process in the licensure system. I am a dentist who has been unemployed for a long time after losing my license in the state of Maine although I harmed no patient or did anything fraudulently. The licensing board refused to accept that one of its members had broken an agreement to turn over her office space to me after she changed her mind about a partnership and didn’t want to leave her old facility. Thus I had to be gotten rid of, and she ousted me and I suddenly had to start searching all over for office space and had no place to see my patients in the interim. Later the Board sought to discredit me be claiming that I was blaming others for my problems and had “distorted thinking”, and insisted that I have psychiatric evaluations and physical exams. Nothing in the statutes gave them this authority, and I was unemployed and scrambling to survive while I was searching for a new office. Ultimately, they revoked my license, and it’s obvious they wanted to eject me from the state for the sake of the board member, not patients. So all my patients had to find other dentists, etc. Now I’m trying to keep my licnse in another state and find work, since my investment in my practice there was wiped out. However, my reputation has been severely damaged and I’ve been financially ruined and have no home, commmunity or friends, etc. So I think it’s quite unfortunate that good people who have suffered a business setback, especially when someone else is involved, can’t get fair and objective treatment by the government, and they get reported as though they are “incompetent”. The many years of expensive training are destoyed, and the public loses out. Many areas in the U.S. have dentist shortages and probably other healthcare shortages, and the number of practitioners is shrinking. Something needs to be done to make the system fair and reasonable.
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