Guest post by Thomas H. Dahlborg, M.S.M., chief financial officer and vice president of strategy for National Institute for Children's Health Quality, where he focuses on improving child health and well-being.
"I went to see my physical therapist in an effort to avoid shoulder surgery. When I arrived, I learned my therapist would be treating me along with three other patients. She would instruct me to do an exercise, and when she could, would turn and rush over to another patient to correct that individual's form prior to doing the same with another, before making her way back to me to correct me as well. Of course, clearly I had been doing my rehabilitation incorrectly (as had my patient peers). I was not engaged but rather scared that I was doing more harm. My therapist was kind, but the system is broken and she was not helpful. I ended up having shoulder surgery, which at first felt beneficial but now that pain is back, my work is in jeopardy and my doctor wants me to begin therapy again." -- Local small business owner and patient
"Payer X is reducing reimbursements for my patient visits significantly. I currently see each of my patients one on one for a full hour. My patients are engaged and activated. I focus on the whole person. We talk. We discuss what is working for them and what is not. We co-create their treatments. And my focus is 100 percent on their care and on supporting their recovery. This reduction in payment level is a barrier to optimal care provision and would lead to harm for my patients. Patient safety would be compromised due to lack of attention from having to see multiple patients at same time; patients will be placed in harm's way and could end up being over-treated (having unnecessary surgery due to lack of progress in rehab); and patients will be disengaged. I will not practice this way." -- Local physical therapist
Plan, Do, Study, Act--otherwise known as PDSA in quality-improvement speak--is critical to continuous improvement. PDSA means:
Plan: the change to be tested or implemented
Do: carry out the test or change
Study: data before and after the change and reflect on what was learned
Act: plan the next change cycle or full implementation
Albert Einstein reportedly said that the definition of insanity is doing the same thing over and over again and expecting different results.
If we tie this to quality improvement, insanity would be skipping the "study" aspect of improvement and thus not reflecting, learning or improving.
Why do I share these stories and these two points?
When faced with the need to reduce healthcare costs, healthcare finance leaders often continue to mandate arbitrary unit cost reductions to decrease medical expense and improve the bottom line.