Goodbye Hamster Wheel, Hello Common Sense


Patient care quality and safety improvements happen on the job, not in meeting rooms. Yet the quest for improvement in many hospitals today takes place in classrooms, where the focus is more on the methodology than on patients and the delivery of care. Furthermore, the intense methodologies are too often a giant step backward for staff in terms of productive, time-efficient use of information.

The need to improve patient care quality and safety has been an item on the hospital executive agenda since the 1999 publication of “To Err is Human: Building a Safer Health System” by the Institute of Medicine.  There has been some improvement over the past 16 years: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) summary report shows some increase in overall hospital rating across the whole U.S. from 64 out of 100 in 2007 to 71 out of 100 in 2013 and 2014 (71 out of 100), with results for part of 2015 remaining at 71.

Judging by the large number of high-cost consultant engagements by hospitals across the country, quality and safety improvements are still high priorities for hospitals.  Additionally, there seems to be an assumption in the executive suite that management and staff don’t have the ability to improve patient care quality and safety themselves, that there must be something added in terms of knowledge, skills or processes that will end up producing the desired results.

Each consultancy claiming a specialty in this area has a proprietary approach, a methodology or a process (or all three) for getting staff on the right track.  The focus is on cognitive behavior change and the communication of concepts and values that staff need to assimilate into their work routines. Staff must leave their daily work to attend seminars or take classes that are meant to improve patients’ perception of the in-hospital experience. The activities that are part of these methodologies do not incorporate technology as a useful or time-saving tool. If anything, they prevent staff from implementing technology that really could make the difference the hospital seeks.

In spite of sizable investment of money and staff time in the various methodologies offered by consultants to improve quality and safety, the HCAHPS score has not significantly changed over the past few years.  More importantly, the scores of actual clinical performance have similarly changed little. Yet the consultants are still going strong.  Why? Most likely because once a company has invested significant resources in a third party methodology, it wants to stick it out in order to get a return. If it’s not working, the perceived solution often is to dedicate more resources to add further services. This produces a “hamster wheel” situation where, whether things are working or not, the company continues to retain the consultancy for more, better and different solutions and continues to take staff away from the very activities that could make the desired improvements.

The way for a hospital to see significant and sustained improvement in patient care quality and safety is to get off the hamster wheel. Rather than writing big checks to companies that take the staff off the floor and that focus on a return to paper management and on changing what is in the heads of the staff, hospital executives need to invest in ways to consistently provide staff with the up-to-date, easily accessed, high-value  information – knowledge and insight, as opposed to basic data.  This enables the staff to make the best decisions for their patients—every day.

Cut losses, stop spending more money on third party “solutions” that involve more work hours you have to pay for (and that aren’t working) and put common sense into play. Keep the staff out on the floor and give them technology, training and modern processes that infuse quality and safety into every activity, task and patient interaction.


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About the Author Faris Islam

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