Hospitals Could Save Lives and Money With Investment in Prevention
The U.S. Health Care System: Really the Best?
A Major League Baseball stadium can hold 38,000 people. Imagine a stadium of joyous men, women, and children filled to capacity. Now imagine this stadium exploding from a gas leak, killing all of the 38,000 innocent people inside. Imagine this tragedy occurring once each month, over and over again. The stadium’s gas leaks are preventable, yet the horrid explosions continue to occur.
I would like to say that this scenario is completely hypothetical, but the sobering reality is that it is not. The real question at hand: Why isn’t our health care system fixing its leaks?
Over 450,000 patients in the United States (U.S.) die each year to due preventable medical errors and hospital-acquired conditions (HACs). The seriousness of the problem was made clear in a 2013 study by the nonprofit Commonwealth Fund, comparing various measures of the health care systems of eleven developed countries. Alarmingly, the U.S. ranked last overall and stood behind most countries on health outcomes, quality, and efficiency. Additionally, the study concluded the average U.S. citizen spends a whopping $8,508 dollars per capita on healthcare per year which is more than twice as much as most countries. Paying this considerable amount of money for one’s health is absurd when taking into account the frequency of poor outcomes encountered in the U.S. healthcare system.
A major issue is competency and engagement of doctors and other health care providers. Currently, the U.S. is beginning to measure the extent of its problems in these areas due to an increased emphasis on clinical transparency and reporting. Promoting healthcare professionals to honestly answer surveys containing similar questions to the following may assist in recognizing lack of provider engagement and competency: Do I know what is expected of me at work? Do I have the materials and equipment I need to do my work right? Have I experienced symptoms of burnout recently? Do I have the opportunity to deliver the best care every day?
Provider engagement includes understanding and agreeing on what is expected in one’s professional role, having access to tools and support that allows everyone to provide the best quality of care, and genuinely caring about patients visibly, openly, and regularly.
But healthcare organizational culture also makes a vital difference. How can front-line providers stay truly engaged if they feel that their healthcare organization management is acting at odds with their mission of providing the best possible care? If upper-level management, in its zeal to fulfill its fiduciary responsibility to shareholders, is causing increased staff burnout due to cuts in budget, resources, and staff, is it any wonder that doctors and nurses are not as engaged as they need to be to prevent medical errors?
Ironically, healthcare organizations may be costing themselves money in the long run by trying to save money in the short term. Hospitals spend substantially more money treating these H.A.C.s than what it would cost to prevent them all together . Furthermore, litigation suits for malpractice are commonly filed against healthcare organizations and providers regarding these H.A.C.s, because they are completely preventable. Now, in addition to the medical and legal expenses of H.A.C.s, the Centers for Medicare and Medicaid Services (CMS) implemented the HAC penalty program as an attempt to reduce adverse events and improve quality of care at the local and national level.
The Centers for Medicare and Medicaid Services are rewarding hospitals financially for delivering services of higher quality, also referred to as the pay-for-performance program. Health care organizations now recognize the need for improved engagement because of its direct relationship patient outcomes and the hospitals financial standing.
Implemented on October 1, 2014, the pay-for-performance program means that institutions that fail to adequately prevent hospital-acquired conditions as surgical site infections, central-line-associated bloodstream infections, and catheter-associated urinary tract infections will face a financial loss — as much as 3% — from their yearly CMS reimbursement. That adds up to millions of dollars for many institutions. Seven-hundred-and-fifty-one hospitals, including local facilities such as Einstein Medical Center, Hospital of the University of Pennsylvania, Bryn Mawr Hospital, and Thomas Jefferson University Hospital were among those deemed under-performers on this measure.
Healthcare organizations should spend money necessary to maximize patient safety up front, rather than comprise ethics and engagement in attempt to increase financial margins. The expenditures and consequences of neglecting competency, engagement, and the best possible care will evidently add up and out outweigh the cost of preventing adverse effects like H.A.C.s and preventable deaths. If an organization ignores this fact, the organizations budget and margins will get even tighter as hospitals will lose money.
For example, imagine a health care organization considering the advantages and disadvantages of an advanced mobile device app technology to improve staff communication. One may argue the implementation of this technology is not beneficial, because it will cost the organization time and money initially. These advanced systems are expensive and may seem complex to some users, thus requiring staff training. But in the long run, the new technology will enhance communication between providers in real time, which will minimize medical errors, hospital acquired conditions, preventable deaths, and overall poor outcomes. Additionally, this coordinated care technology will boost patient experience and staff satisfaction though the increase of timeliness and efficiency of accurate communication throughout the organization’s operations. An organization may opt to not integrate this more efficient and timely technology because of short-term financial pressures, but the app’s minimization of medical errors, hospital acquired conditions, preventable deaths, and poor outcomes will save money ultimately.
Health care organizations need to learn that in putting forward the money required for optimal engagement in advance, health care organizations and patients will save substantial amounts of money in completely eliminating unnecessary costs in preventable illnesses or deaths and hospital acquired conditions. The money lost in lawsuits, fines, lack of reimbursement can then all be put toward boosting the delivery of quality care even more. The growth of engagement guarantees the use of all resources necessary to ensure the delivery of the best practices. In the long run, healthcare organizations will save money by implementing the means of enhancing engagement beforehand. The betterment of health care provider engagement brings about the increase of provider accountability, transparency, and competency in effect. I believe this transformation into genuinely engaged providers will place the United States’ healthcare system at the top of world ranks, and show that a successful practice can truly remain an ethical one.
Andrew Murphy is a sophomore biology major and fellow at Ursinus College’s Center for Science and the Common Good.