The Final Word: Our biggest failure in health care

Tuesday, July 01, 2014 12:58 PM
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by Gary D. VanderArk, MD, CMS Past President

Gary VanderArk, MD
Gary D. VanderArk, MD

Our biggest failure in health care is a lack of communication. Lack of communication produces more than 100,000 deaths per year and 100,000 injuries to hospitalized Medicare patients each month. Lucian Leape, MD, a Harvard Health Policy Analyst, says, “Health care’s dirty little secret is that nobody is responsible for coordinating care.” Ineffective communication is responsible for 80 percent of all adverse incidents, 71 percent of all malpractice claims, and 70 percent of all Joint Commission “sentinel events.”

Coordination of care must involve communication, knowledge and good relationships. Coordination of care involves not only the health care system but social service and public health systems as well. Then to be complete, we must include the patient in their home setting. There is a strong positive relationship between a provider’s communication skills and a patient’s capacity to follow through with medical recommendations.

To communicate care we must gain access to and integrate services and resources. Then we must link services with the patient and family. We should avoid duplication and unnecessary cost and advocate for better outcomes. Shared decision-making becomes more complex each year as new discoveries are constantly being made.

The Affordable Care Act makes coordination of care and communication mandatory, or at least reduces reimbursement. Patients will now judge how efficiently we communicate and hospital reimbursement for Medicare patients will consider patient satisfaction.

The federal government also encourages all providers to meet HITECH use requirements. The Health Information Technology for Economic and Clinical Health (HITECH) Act which amended HIPAA in 2013 was specifically designed to provide the necessary assistance and technical support for providers so that every American can benefit from an EHR (Electronic Health Record) as part of a modernized, interconnected and vastly improved system of care delivery. The Act establishes incentive payments under the Medicare and Medicaid programs.

Is the EHR really going to improve communication? Fifty percent of all communication in health care is still face-to-face. Will EHR change present data that suggests that half of all hospitalized patients do not know their diagnosis or the names of the medications they are taking?

There are so many barriers to communication! Gender, ethnicity, culture, language, jargon, personal values, commitments, schedules and many more factors hinder effective communication. Add those to attitudes, behaviors, morale, memory, stress, fatigue, distractions and interruptions and effective communication does not happen.

Communication is most likely to fail at times of transition. When we pass the ball, it gets dropped. Successful hand-offs are critical. Transitions of care are where we make mistakes. There has to be a system. The aviation industry has a system called Crew Resource Management (CRM). Because of CRM we all fly safer. Each member of the crew understands exactly what their role is and how they are to respond to any situation. Many large medical groups, including Kaiser Permanente, are using SBAR to improve transitions. SBAR stands for Situation, Background, Assessment, and Recommendation. This means that each provider must respond to the following four questions in making a handoff: 1) What’s going on with the patient?; 2) What’s the patient’s history?; 3) What do I think the problem is?; 4) What would I do to correct it? Hand-off communication performance has been proven to decrease adverse events by more than half.

The answer to improving communication in health care is to become a team – a group of individuals who work together to produce products or deliver services for which they are mutually accountable. TEAM means Together Everyone Accomplishes More! Health care teams must have regular meetings to define objectives, clarify roles, apportion tasks, encourage participation and handle change.

The ten requirements of a health care team:

  1. Demonstrate reliability
  2. Communicate constructively
  3. Listen actively
  4. Participate actively
  5. Share openly
  6. Cooperate and pitch in
  7. Be flexible
  8. Show commitment
  9. Work as problem solvers
  10. Treat everybody with respect

Bill Russell, Hall of Fame center for the Boston Celtics, said: “The most important measure of how good a game I played was how much better I’d made my teammates play.”

Health care is changing and we all must change too. There must be a new focus on quality and efficiency. We must agree on standardized functions. We can eliminate unnecessary steps and automate any work that can automated. We can delegate work to appropriately trained non-physicians. We must progress to patient-centered care by activating and engaging the patient and their family. Jerry Garcia of the Grateful Dead said: ”Somebody has to do something, and it’s just incredibly pathetic that it has to be us.”

The new world of health care must involve cooperation, communication and collaboration. We can! We must! We will!


Posted in: Colorado Medicine | Final Word
 

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