Market Research: The Source of Improved Health in Healthcare Reform

Recently I tuned into a speech on C-Span, entitled "The Future of American Healthcare" regarding healthcare's top priorities for near future change, given by Mayo Clinic CEO Dr. Denis Cortese. While not the finest speaker in the land, Dr. Cortese called for elegant solutions to today's most vexing health system problems.

Specifically, Dr. Cortese called attention to the fact that greater than 50% of all healthcare dollars are wasted on unreliable care in this country. Wow! That's a startling statistic! A great deal of this waste comes from mistakes and clinical errors leading to loss of life. My friend and colleague, Nick Devenney, has reiterated this claim for years. American hospitals are responsible for more than 100,000 deaths each year for people who were otherwise not terminal.

So you go into a surgical procedure, with all kinds of reassurances from your physician ("It's very routine, we'll have you back on your feet in no time."), and you wind up in a morgue because somebody on the surgical team didn't wash their hands since examining the last patient (who happened to have a staph infection). We used to hear urban myths about nurses or doctors leaving surgical instruments and sponges inside the body cavities of their patients; turns out this is a relatively common occurrence!

Dr. Cortese suggests that American Hospitals begin to develop a learning culture where all information about procedures and patient outcomes are shared throughout the nation. As we learn how things happen, we develop practices and standards of performance that lead to fewer and fewer defects. He further suggests appointing a Health Czar who reports daily directly to the United States President how many people were killed by the health system last night, and how will we prevent these kinds of deaths in the future.

Notwithstanding the expertise and passion brought to the table by the CEO of Mayo, WHY has it taken us this long to address this problem? Why doesn't our country have a central repository of health practice information to share across all lines of practitioners? Why aren't we learning collectively from common and preventable mistakes that are tragically taking lives unnecessarily?

The answers can be found throughout the health system at-large, and indeed, throughout corporate America. Decision-makers are focused on fixing today's crises, reacting to the consequences of decisions made years ago. Ours is a business culture that prefers to make decisions from the gut, rather than the collection and leverage of reliable market research data to let us know how we're doing, what areas need attention now before they become crises, and what areas are we showing improvements with the actions we have taken.

You may not think of American healthcare as a business, but at 16+% of GDP and rapidly growing, it's the largest business enterprise we have. And this business needs to do a better job of accessing its many constituents that shape how health is delivered, utilized, and indeed, accounted.

What are your thoughts? Is America's health system crippled by a reactive mindset and overpowering the cost escalation curve, or is there finally some movement toward improving the delivery of care with attention to better outcomes and successes? What pockets of performance are especially enlightened? Where can you get your operation and have the lowest chance of an accident?

----Michael

Comments

[francine hardaway]

These are huge questions. Some of them are being considered by SLHI (www.slhi.org) in its research and white papers. We should really keep this discussion going; I have a wealthy friend who nearly died of a hospital-induced staph infction.

[Mike Cylkowski]

Shannon Brownlee, author of "Overtreated", goes into numerous descriptions of unnecessary treatments. Her research and those of others she quotes looks at the incidence of any procedure being done more often when a propensity of physicians in that specialty occupies a geographic region.

[michael harris]

"Overtreated" speaks to one critical issue within the sphere of this huge challenge: physicians spurred by competition to provide as much heavy-handedness as possible with each patient, perhaps to avoid that patient migrating to a competitor. This is above the substantial aspect of mistake-making and errors due to lack of following proper clinical protocols. And this number does not include the mortality from unsuccessful well-intentioned, well-administered treatment. Imagine the lost productivity to society from the unnecessary loss of 100,000 people every year. It's crazy!

[michael harris]

I looked into the St. Luke's Health Initiative web site and discovered a wealth of research and white paper material, much of which is secondary data collection and conference topic work efforts. Funny, and perhaps I missed it, found no mention of error rates, learning culture, or 100,000 unnecessary deaths due to improper medical attention. Lots on healthcare reform, tort reform, and especially, insurance industry reform.

[Kevin Lieb]

Hi Michael, great questions and disturbing statistics. I grew up in a 'healthcare' household, my mom is a nurse, so I heard all about 'stuff' that happened at the hospital. At the time it made me swear I'd never have anything to do with a hospital. But alas, I've ended up working with and in hospitals for 15 years! And the one thing I've discovered and am constantly amazed by is that our health system is run like a bunch of 'mom and pop' stores. I'm not a doctor but to me its amazing how varied the approaches are to treating the same disease. Take heart disease, the #1 killer of Americans. Line up 20 doctors in front of one patient and you'll get 20 different answers for treatment. Layer on top of it the byzantine infrastructure that's evolved over time and It's no wonder the industry is failing.