I wrote a comment, which is awaiting moderation, and I’ll repost it here…. also curious to hear your comments on his blog or here on mine.
From his column:
Hospitals were co-dependent. All too aware of their heavy reliance on the physicians’ control over their revenue stream, hospital administrators learned to coddle doctors, with everything from prime parking spots to a personalized menu of surgical equipment. This kept the doctors happy, but also led to wildly expensive and sometimes risky variations in practice, even within the same institution.
This reliance also made everyone tiptoe around the dysfunctional behaviors that Dr. House so memorably illustrated each week. In one survey of more than 700 nurses, 96% reported seeing doctors engaging in disruptive behavior, and almost half pointed to fear of retribution as the reason such acts went unreported. Another survey found that one in four doctors and nurses believe that disruptive behaviors are associated with preventable deaths. I agree, having seen cases of medical errors in which a scrub nurse or physician trainee suspected that a senior doctor was about to commit a terrible error, but kept quiet rather than risk the physician’s ire.
Great piece, Dr. Wachter. I grew tired of the show and the character… he’s a drug addict, but he’s talented. He’s misanthropic, but boy we sure need him.
As somebody who was an outsider to healthcare seven years ago (from an engineering background), I was blown away by the disruptive behavior that was reported and tolerated in hospitals… behavior that wouldn’t be tolerated and excused in most workplaces.
You say hospitals “were” dependent on physicians for their revenue stream… I think that’s still often true in the current tense.
As more hospitals embrace the “lean” management methodology, they learn that one of the two pillars, from Toyota, is “respect for people” â€” and how that mutual respect is required to have an environment of safety and quality. It will be interesting to see how healthcare reconciles the old mindsets with the new mindsets of lean and the modern patient safety movement.
Your thoughts and reactions?
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