Variation in healthcare delivery: The need for standardization

The world of healthcare is exceedingly complex. In particular, variation in the delivery of healthcare is a fundamental concern with the lack of standardization directly affecting the ability to ensure safe care. While this problem is often acknowledged, not enough has been done to solve it.

Conversely, we’ve seen some industries, including automotive, nuclear, and even aerospace, respond to major safety crises by standardizing processes to ensure consistency among the workforce. This has resulted in a level of uniformity that has allowed these industries to perform their job functions with fewer incidents and better overall results.

Unfortunately, healthcare has not followed the same path. Not only is there still a significant divide in the ways different hospital systems deliver care, but variations exist between different departments within the same system and among individual providers within the same department. This is problematic for multiple reasons. It may lead to decreased patient safety and heightened confusion for both the patient and physician. In addition, when hospitals see a negative patient outcome, it can be challenging, if not impossible, to determine whether or not proper measures were taken to avoid the outcome if no baseline for such measures existed in the first place.

There is no question that healthcare is an intricate equation. Every patient is different, and each person has his or her own personal story. However, at the core of patient care, processes that are agreed upon by the physician community can and should be uniformly implemented to better inform clinicians as to how best treat their patients. While we currently may see similarities in healthcare delivery across various organizations and practice areas, what we don’t see is standardization.

Several sets of best practices have been identified and suggested for the industry that could make a major impact on the way healthcare is being delivered. The Joint Commission, for instance, has a library of best practices for healthcare professionals that is easily accessible. Similarly, the National Patient Safety Foundation and the Agency for Healthcare Research and Quality (AHRQ) have laid out a number of guidelines and recommendations for medical professionals and will occasionally recognize institutions or hospitals with distinction for following them. One obstacle, however, is that no legal mandate requires organizations to follow these guidelines, nor is any recognition incentivized. The result: many organizations choose the guidelines that are easiest to implement based on time, budget and desire, or follow none of them.

Similarly, the World Health Organization has developed a surgical safety checklist with safety procedures that should be followed during every surgery. It is broken down in three key stages: before induction of anesthesia, before skin incision, and before the patient leaves the operating room.

Each of these safety procedures lists a number of important questions that the surgeon, anesthetist, and nursing team should ask during every stage of the procedure to ensure that adequate safety standards are met. The guide itself was built on data from malpractice claims and contains valuable best practices that should generally be implemented across the board. Because there is no legal mandate, these guidelines are regarded as discretionary and implementation has been inconsistent.

While there is still room for improvement, the healthcare industry has made progress in recent years. Some organizations, most prominently, Centers for Medicare and Medicaid Services (CMS), frequently tie hospital reimbursement to value-based measures in an effort to improve patient safety and reduce readmissions. Such a system reflects the belief that if reimbursement is based on actual patient outcomes and other designated quality metrics, providers will be incentivized to voluntarily implement more of these best practices.

There is widespread acknowledgement across healthcare that standardization of processes is needed, but the debate frequently revolves around on how to achieve this. The treatment process can differ widely by hospital, and even by doctor, but there is little agreement within the industry on who does it “the right way.”

Greater proactivity is needed and the key to determining where the greatest risk lies is through analyzing existing data. Analyzing previously-filed malpractice claims helps professionals identify each case’s root cause. Coding these primary causation factors assists in the creation of aggregated data that identifies the most common types of claims, painting a picture of the past to help assess hospitals and medical centers moving forward.

Such risk assessments allow analysts to determine where institutions would benefit the most from standardization, as well as, the exact procedures they should implement to overcome deficiencies. This information can then be leveraged to inform a series of responsive recommendations and detailed best practices that are tied to the areas where there is a particularly heightened level of vulnerability. Our data has historically shown four specific areas that are based on previously conducted assessments and present the greatest risks for hospitals and health systems. These resulted in the most dollars lost: missed or delayed diagnosis, unexpected surgical outcomes, obstetrics, and medication error.

The healthcare industry should determine and implement a core set of mandatory best practices for leadership and staff to ensure that they are no longer discretionary. Variability too often can result in tragedy -- we see that day after day in malpractice cases. It’s now up to the healthcare industry to ensure consistency.

Robert Hanscom
Vice President, Business Analytics
rhanscom@coverys.com

Robert Hanscom joined Coverys in August 2013 and serves as the vice president of business analytics. He is responsible for oversight of enterprise-wide data quality, data governance, comparative benchmarking, and the advancement of analytics to support the business in delivering on its overall strategy.

Hanscom earned a Juris Doctorate from Pepperdine University School of Law and a Bachelor of Arts degree in history from Pacific Union College in California.

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