Notes & Links: September 24, 2013

Stunning News on Preventable Deaths in Hospitals
Leah Binder contributor to Forbes guides us through the most recent data on preventable deaths in US hospitals. Binder provided some reference points that are worth noting and keeping on file. 

  • In 1999 98,000 patients were dying annually from preventable errors in hospitals
  • Today it appears we are seeing 440,000 deaths from preventable errors in hospitals
  • Medical errors are the third leading cause of death in the US way ahead of auto accidents, diabetes, etc.

The reason for these deaths?

These people are not dying from the illnesses that caused them to seek hospital care in the first place. They are dying from mishaps that hospitals could have prevented. What do these errors look like? The sponge left inside the surgical patient, prompting weeks of mysterious, agonizing abdominal pain before the infection overcomes bodily functions. The medication injected into a baby’s IV at a dose calculated for a 200 pound man. The excruciating infection from contaminated equipment used at the bedside. Sadly, over a thousand people a day are dying from these kinds of mistakes.

This bears repeating. Over 1,000 people a day are dying from preventable errors in hospitals in the US. 

I was not surprised to learn that hospitals are shifting the cost of these 1,000+ errors a day to the patient, taxpayer, and business buying healthcare. Well here is a surprise, a study by JAMA found that employers paid an additional $39,000 extra each time an employee had a surgical site infection. Cost shifting at it most stunning. 

As Binder points out this trend falls squarely on our shoulders since we allow lobbyist to hide errors, we fail to insist on safety when we seek care, and we don’t demand safety. I agree and perhaps once the price transparency of hospital costs is begun safety will be next. It has to be.

Social and Self-Reflective Use of a Web-Based Personally Controlled Health Management System
Lau, Dunn, Mortimer, et. al take deep prospective look at how consumers use social media and diary/personal health records of a Web-site to support their physical and emotional well-being. Compare their work to the link below on Understanding the Drivers of the Patient Experience. What would you use to understand and improve patient centric medicine at your hospital or practice? 

The authors present the issue this way:

To date, it remains unclear how we can best integrate online social networking features and self-reflective tools (such as PHRs) into the design of PCHMSs in order to maximize consumers’ uptake, improve their health behaviors and outcomes, and facilitate their long-term use. In particular, few studies have examined the mutual relationship between self and the crowd in influencing one’s health behaviors. Utilizing a multimethod approach (statistical, content analysis, and social network analysis), the aims of this paper were as follows: (1) to measure how consumers used the most common self-reflective features in a PCHMS, (2) to measure how consumers interacted within the community created by the social features of the PCHMS, and (3) to provide recommendations on ways to engineer a socially driven and self-reflective PCHMS that would improve individual health behaviors.

Self reflection is one of the key components in learning and changing behavior. Reflection in action as described by Schon is the reflection that occurs during the time a problem is bing examined and understood. It is how we add new knowledge to a problem we have and create a new set of data to act on. 

The conclusions of the authors speak to my contention that we find ways to help consumers “become familiar with their personal concerns” as in solve problems. That is what we healthcare is doing at its most basic, solving problems. And I believe the more active all participants are in solution finding, behavior, and measure the better we will find our healthcare system. 

Incorporating the two major trends in consumer eHealth research (ie, PHRs and online social networks) to inform the next generation design of consumer systems requires several novel considerations. This study provides preliminary findings that suggest a PCHMS should include both social and self-reflective features that allow consumers to become familiar with their personal concerns and connect with others to seek help. With the rapid growth of online social networking websites and PHRs, future designs of PCHMSs should explore novel ways in which we can intervene in a person’s level of self-awareness and social network and examine their efficacy as a complex social and self-reflective intervention for health.

This is an important and valuable study that points to ways EMR and Web sites can be leveraged to improve patient care and outcomes. Less market research and more outcomes driven knowledge upon which to act. 

Understanding the Drivers of the Patient Experience
Merlino and Raman writing in the Harvard Business Network Blog offer some valuable insight on how hospital administrators have NO insight. The authors examine and question the reality of being patient centric and what is the patient experience. 

Drivers of the patient experience are the new black in healthcare and critical in the brave new world of Obamacare. But are hospitals taking a serious and critical cut at what is or will drive the patient experience? I will add my own thoughts here, the patient experience is a moving target. As new healthcare rules are implemented and  health related data is released drivers will be changing and becoming more focused on care and outcomes and less on rooms with a view and curtains.  

Least we forget, the patient experience today is being driven by social media and what the patient needs to learn in order to becoming an active and receptive healthcare consumer. In my opinion it is less about market research and more about needs assessment and identifying the problems patients are seeking to solve in order to ensure hospitals and their HCP become a trusted and valuable learning source. 

Merlino and Raman state:

A 2012 industry survey asked top hospital leaders (CEOs, COOs, and others) what was necessary to improve the patient experience. The top six recommendations included: new facilities, private rooms, food on demand, bedside-interactive computers, unrestricted visiting hours, and more quiet time so patients could rest. There was one problem with them: They were not based on a systematic examination of what most patients really wanted. In other words, hospital executives wanted to focus on what they felt were important drivers of the patient experience but didn’t know for sure.

The authors list four approaches to identifying patient drivers. 

  • Advisory councils
  • Deeper look into patient experiences
  • Rounds with hospital leaders
  • Tell Stories

These are excellent tools and exercises but I worry they will only determine what is de rigueur and not the ongoing long-term needs and goals of patients.