Not ‘cook­book medicine’

Providers face push­back in move to stan­dard­ize

Modern Healthcare - - COVER STORY - Andis Robeznieks

The move­ment to stan­dard­ize med­i­cal prac­tice pat­terns, a key com­po­nent of im­prov­ing qual­ity, is still a work in progress as hos­pi­tal of­fi­cials seek­ing to in­stall com­mon pro­to­cols con­tinue to en­counter pock­ets of re­sis­tance among physi­cians.

When Univer­sity of Colorado Hos­pi­tal, Poudre Val­ley Health Sys­tem and Me­mo­rial Health Sys­tem re­cently came to­gether to form the Univer­sity of Colorado Health sys­tem, the Aurora-, Fort Collins- and Colorado Springs­based en­ti­ties each had their own rules and pro­to­cols that they con­sid­ered “best prac­tices.” That had to end, sys­tem of­fi­cials de­cided.

“Dif­fer­ent or­ga­ni­za­tions used dif­fer­ent tools, so one of the first things we had to do was find one set of mea­sures so we could com­pare ap­ples to ap­ples,” said Ru­lon Stacey, UC Health pres­i­dent. “There was some ten­sion to get the or­ga­ni­za­tions to agree on which ones we’d use, but one of the things we’re pretty adamant about is that we only use one mea­sure or stan­dard.”

Some physi­cians may still de­ri­sively re­fer to the use of ev­i­dence-based stan­dards as “cook- book medicine” or ar­gue that stan­dard­iza­tion sti­fles in­no­va­tion, but Dr. Kedar Mate, vice pres­i­dent of the Cam­bridge, Mass.-based In­sti­tute for Health­care Im­prove­ment, said the ev­i­dence is over­whelm­ing that in health­care—or any in­dus­try—stan­dard­iz­ing parts, pro­cesses and peo­ple’s roles re­duces de­fects. In health­care, that trans­lates into re­duced pa­tient harm.

“The de­gree of be­lief in stan­dard­iza­tion is ris­ing, but there still needs to be lo­cal trans­la­tion to what it means for qual­ity,” Mate said.

Stacey said his goal is that “cus­tomers” re­ceive the same level of high-qual­ity care no mat­ter which UC Health fa­cil­ity they visit. He added that he’s heard the pro- and the anti-stan­dard­iza­tion doc­tors use the same ar­gu­ments against each other. “They point to each other and say the other is sac­ri­fic­ing the pa­tient for their own ben­e­fit,” Stacey said. “So, if they say, ‘My way is bet­ter,’ they have to show me the data to prove it.”

One area of dis­pute at UC Health was in de­vel­op­ing pro­to­cols for pre­vent­ing pa­tient falls. Stacey, the for­mer CEO of the Poudre Val- ley sys­tem, said some at the Univer­sity of Colorado Hos­pi­tal felt their pro­to­cols were bet­ter, but Poudre Val­ley clin­i­cians had the data to show their pro­to­cols worked best.

He said com­mon stan­dards need to be in place for a roll­out of a new sys­tem wide elec­tronic health record go­ing live on the sys­tem’s north side in July and on its south side in Novem­ber. “The nurses and doc­tors are do­ing an in­cred­i­ble job go­ing al­most pro­ce­dure by pro­ce­dure,” he said.

En­gle­wood, Colo.-based Catholic Health Ini­tia­tives, which has about 480 physi­cian prac­tice sites across its 17-state en­ter­prise, has sought to im­ple­ment a high de­gree of stan­dard­iza­tion. Dr. T. Clif­ford Deveny, CHI se­nior vice pres­i­dent of physi­cian ser­vices and physi­cian prac­tice man­age­ment, said the keys to physi­cian and staff buyin of stan­dard­ized best prac­tices is to have a trans­par­ent process, in­volve the peo­ple af­fected, and have them take own­er­ship of the process and the re­sult. “The se­cret has been that there is no se­cret so­ci­ety telling you what to do,” he said. “It’s a grass-roots ef­fort.”

Mate said stan­dards should be ad­justed when clin­i­cal cir­cum­stances dic­tate. And, if th­ese “vi­o­la­tions of pro­to­col” were recorded on­line and stud­ied, he said stan­dard­iza­tion could re­duce from years to weeks the time it takes for in­no­va­tions to de­velop.

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