Not ‘cookbook medicine’
Providers face pushback in move to standardize
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.