Wednesday, November 22, 2006

What Do You Want From Your Hospital?*

I've come to the sad conclusion recently that the penultimate US cultural paradox is the "Health"(broadly defined) of US Hospitals and as a subset the health of US health care workers within all strata. In short, the 5000 or so US hospitals are in deep trouble- very deep trouble. They have lost their way and may not be able to find their way back unless they are radically transformed in my opinion.

What evidence do I have to make such a sweeping pessimistic statement? To begin let us start with the fundamental issue of how safe hospitals are? (Seems a rather odd question to pose for institutions whose fundamental purpose is to cure or heal the sick or restore the injured?). But since the release of the landmark NIH report "To Err Is Human: Building a Safer Health System (2000)Institute of Medicine (IOM) on medical errors stating that then medical errors were the 8th leading cause of death in the US in my opinion not much has changed? Although there are a few rays of hope in Institute of Medicine. Preventing Medication Errors. Washington DC: National Academy Press; 2007.

Furthermore some estimate that medication errors are the 4th leading cause of death in the US. Hospital Acquired Infections (HAIs) have alarmingly rise in recent years and now number anywhere from 5-10% of the @35 million Americans admitted to the hospital each year. (see Emerging Infectius Diseases, Vol. 7, No.2, March -April 2001)Violence and crime have increased in hospitals recently especially in emergency room settings in inner city intitutions where paradoxically some of our greatest teaching hospitals reside.

Hospital billing systems are broken with with estimates by some that a whopping 95% of hospital bills having one or more errors. Many hospital Health Information Technology systems, (HITs)while holding great promise, have been poorly implemented leading to negative consequences.

Many hospitals are in severe financial crisis and may go the route of bankruptcies not unlike the US Airline Industry (see Health Affairs Vol 25, No 1- Jan/Feb 2006- "Could US Hospitals Go The Way of U.S. Airlines" by Stuart H. Altman, David Shactman, and Efrat Eilat from Brandeis University.)

Perhaps at the core of why hospitals are broken so badly are three critical issues

- Hospitals (even so called non-profits) are driven almost exclusively by a market driven business model which has abysmally failed

- Hospitals cannot plan because they have no planning roadmap given their justifiable requirement to operate under seemingly everchanging government driven oversight, legislation and regulations

- Hospitals have deified technology to an extreme irrational and costly degree. They have grossly failed to recognize that while their patient/customers want good technology- that patients also want and deserve that their social, psychological and spiritual needs be addressed/met. In short technology is good but simply incomplete. I call it the need for "Bio-Medicine Plus"

Technology "bites back" when overused says Edward Tenner from Princeton. Why Things Bite Back: Technology and the Revenge of Unintended Consequences (Vintage) by Edward Tenner And Diana Dutton believes in many cases our medical interventions are "Worse than the Disease": Pitfalls of Medical Progress" by Diana Barbara Dutton. Drs. Elliot Fischer and Gilbert Welch of the White River, VT.,VA hospital published a most compelling and convincing paper in JAMA entitled "Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse?"( SPECIAL COMMUNICATIONS:Elliott S. Fisher; H. Gilbert Welch-JAMA, Feb 1999; 281: 446-453)

On the brighter side:

- Lives are saved every single day in our nation's hospitals

- Election Day November 2006 Was a Good Day for Health Care? says Karen Davis -President and CEO of The Commonwealth Fund

- Innonvative hospital leaders like those in The Planetree Hospital Movement are not giving up

- Western history and other cultures have much too teach us.

My personal take on hospitals as a 61 y/o doctor. Well, in the 1960's and 70's patients could not find a parking space at our best teaching hospitals. Progress has been made on that front.

As a Med student I would routinely get physically lost in the huge academic hospitals where I trained and I wondered how the patients and visitors were faring? That too I am happy to report has improved.

Generally though I am disheartened and disgusted by the state of health of most US Hospital. I am freightened for myself, my family and friends who enter at them own risk and for my colleagues who work therein.

What do you want from your hospital? How can we achieve that. Please let us hear from you?

We have a moral imperative not to give up. As America "greys" we obviously need good healthy hospitals more so than ever.

Dr. Rick Lippin

*PS- This essay was in large part stimulated by the proposed sale of arguably the most important piece of 19th century American Art (The Gross Clinic painted by Thomas Eakins) by Thomas Jefferson University for $68 million dollars to Wal-Mart heirs in Bentonville, Arkansas- representing the ultimate "triumph" of the marketplace over the core of what health care should be all about.-ral


Anonymous Anonymous said...

Good post, Rick. As a consumer and not a doc, I see:

--personnel shortage,
--mass of records and tape,
--administrative mistakes Ross Koppel has documented so well, and
--fallacious treatment of healthcare as a market sensitive activity!
What I learned we need as a member of the National Blue Cross Advisory Board and a stint on the medical manpower commission of DHHS, many years ago:

--better wages and training for administrative employees,
--reduced workloads,
--increased student subsidy of nursing, tech and medical education,
--eliminate the insurance companies at the community level in a quasi-public, quasi-private single payor system,
--finance in part through industry sector coops,
--end of for-profit hospitals and insurance companies,
--end of parallel systems, such as the workers' comp mess,
--strong community control with LIMITED federal involvement of entire healthcare system [end self-perpetuating boards!!]
Shel Samuels

1:21 PM  
Anonymous Dr. Rick Lippin said...

Thanks Shel- Among the many issues you raise, the health of health care workers is a topic of interest we especially share as Occupational Health professionals.

I cannot fathom how health care leaders can live with the hypocrisy of poor wages,poor benefits,poor working conditions and subsequent poor health of hospital employees.

I say Medicine needs to "heal from within" and start by giving decent wages, benefits and working conditions to all health care workers.

Thanks again for the comments

Rick Lippin

4:58 PM  
Blogger Mrs. Kramer said...

What Do You Want From Your Hospital* you ask?

Medical treatment based on the physician's opinion of what the patient needs, rather than what the insurance industry dictates that the physician's opinion must be.

To quote a friend:

"Mandated, insurance sponsored, treatment guidelines limit patient access to
appropriate health care and cause the financial burden of sick and injured to shift onto state and federal disability programs. This allows the carriers to increase profits at the expense of the sick, the injured and the American taxpayer."

Hospitals are broke. Patients are broke. State and Federal disability programs are broke. So let's see, where did all the money go?

5:19 PM  
Anonymous Dr. Rick Lippin said...


Thanks for your insightful comments.In my opinion there needs to be some methods of reducing expenditures in medicine. My "favorite" example is the cruel and inhumane prolongation of death?

But you ask-"Where has all the money gone?" To a few CEOs of the Hospital, Insurance, and Big Pharma/Big Medical Technology industries. And of course to greedy doctors and lawyers.

With the election of Nov 06- "changes are a-comin"

My very best to you

Dr. Rick Lippin

6:00 AM  
Blogger universal health said...

Your points are well taken. But there seems to be a small oversight - no mention of professional nursing in your analyses of healthcare problems. Nurses are not furniture and interchangable widgets in the healthcare system. Rather, they are the spine and skeleton by which the entire non-system system builds upon.

I blog at Universal Health attempting to bring nursing issues to light and to posit some alternatives which include nurses in the equation. I hope you'll visit and critique.

7:39 PM  
Anonymous Dr. Rick Lippin said...

Thanks Universal Health- I am appalled at what has happenned to the so called profession of Nursing in contemporary US Medicine.I am disgusted with what modern medicine has done to the health of Nurses.

Dr. Rick Lippin

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