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by Lynn McVey
If you were ever lucky enough to hear Atul Gawande, M.D., speak, you're lucky enough. I always defended and held my beloved healthcare system in high regard. As I began to explore the writings of Gawande, Shannon Brownlee, Martin Makary, Andrew Grove, etc., I was embarrassed by my naivete. Once, on a 5-hour flight, I was seated next to a highly paid health insurance CEO. I began with an apology and acknowledgment of his apparent lack of luck. "You can't tell me we don't have the best healthcare in the world," he opened with. I showed him where the U.S. ranked in healthcare outcomes (64 of 198 countries) and where we ranked in expense (1 of 198). Five long hours later, I believe he left that flight a bit smarter.
When I first read this recent quote of Gawande's: "Technology is not the main force driving healthcare improvements," I had a tiny, little heart attack. Thankfully, I continued to read. "We have one opportunity to leverage technology to improve care. That opportunity is data."
Data is healthcare's only tool to start correcting this complex and complicated healthcare mess. For me, it is impossible to manage operations without metrics. Myers-Briggs told me I'm not very emotional or sensitive. I do not sense without input. When asked how their departments are running, an emotionally based manager will answer, "Morale is high, patients don't wait, doctors are happy," whereas an evidence-based manager will answer, "HCAHPS scores have risen 15 percent in last 12 months, expenses are down 12 percent, revenues increased 4 percent, and CORE measures are 10 percent better than last year."
Year ago, I attended a hospital-wide quality committee where the quality director announced we had four falls that quarter. I was surprised when nobody asked for clarification. She went on to announce that four patients waited greater than 1 hour for a CT scan. In a huffy fit, the CEO demanded that I do a root-cause-analysis to find out why four patients waited so long. (In the past, I usually discovered CT delays were linked to contrast, which may take 90 minutes to prep). I did manage to respond that 22,000 or 99.9 percent of our CT scan patients were scanned within the 1-hour benchmark, which makes four delays statistically insignificant.
I then asked for clarification regarding our patient falls. Was it four falls of 400 patients, which would be atrocious, or was it 4 of 4,000, which would also be statistically insignificant. Although this happened about 10 years ago, I continue to hear similar meaningless reports. To me, this means we are nowhere near being a data-driven industry. Ugh.
So, how do we lead change from emotionally based management to evidence-based management? Change, by definition, is what good leaders do. Change is the hardest thing to achieve. Change is the place where risk meets return. But where is the risk in changing from emotion to evidence? Aha! Glad you asked.
The risk of providing evidence and metrics is that now you are being measured. And what if you don't measure up? Once you discover which departments are carrying expensive variations, you can immediately repair them. I feel the risk is bigger if we keep our heads in the sand. Many "have-not" hospitals are struggling to stay open while many "have" hospitals post millions of dollars in expenses and revenues. There must be equity in U.S. healthcare because that's the right thing to do.
"Anything easy ain't worth a damn," coach Woody Hayes so famously and eloquently said.
Lynn McVey serves as chief operating officer of Meadowlands Hospital Medical Center, an acute care, 230-bed hospital in New Jersey.
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