US Hospitals Are Wastefully Inefficient

Parent Cafe
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<p>I hope I am not alone in these criticisms…</p>

<p>Let’s start with bureaucracy. When it comes to managing paperwork, hospitals seem horrible. I say this as someone as a student who works in a clinical trial unit and regularly has to process patient data and send patient data between units. There are so many simple reforms I can think of that would improve the rate of data processing by about to 50% while maintaining patient confidentiality or even improving it. </p>

<p>One time, the undergrad assistants at my unit wasted half a day looking for a Medical Supplies Requisitioning Form that was located on a privileged-access network SMB share – we couldn’t access it because the previous administrative assistant of our unit (who essentially built it from scratch in conjunction with a medical researcher MD/PhD) had been promoted and had left our unit. Considering you still need to write all sorts of access codes on the form in order to get anything, there’s no reason why this shouldn’t be available on a centrally-located website or database. Hell, the whole process should be automated.</p>

<p>The lack of interunit communication. Resources are not pooled. Units next door will be puzzled by relatively simple requests (like, “do you have an MSR form? Do you have printer ink?”). God forbid something medically important pops up. </p>

<p>Underutilization of resources. Nurses and other assistants frequently sit idle while units next door are overwhelmed. Is this by design? Each unit is like its own world, quarantined away from the next one.</p>

<p>Why do Americans abhor wards? Each bed is located in a spacious, hotel-room like environment. When a patient is immobolised, I am not sure if this is necessary. And sometimes, social interaction is good. There is so much that can be done to maximise the quality of healthcare while at the same time without wasting precious floor space.</p>

<p>Physical file transfer systems. Instead of wasting time and labour sending people to busboy files across to another labyrinth of a building and back, I am sure investing a million dollars (I am sure with mass production it will even be less) to have a sort of physical “traintrack system for medical files” that runs across the ceiling will reap many dividends in the long run. I see these frequently in many international hospitals, especially in the country of my birth.</p>

<p>But then again, US Hospitals appear to have no incentive or pressure to improve themselves. They don’t have any quality control procedures…is it any wonder that the costs of healthcare are so high?</p>

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<p>If you are so sure you could fix it… then why don’t you go into hospital administration? Most of the decisions you are talking about are made there. Just note that there are MANY reasons why things are the way they are in US hospitals; I have worked in several on the business side, and it is not as easy as you might think to modify procedures, forms, etc. There is a pretty wide variety across hospitals, too, regarding many of the issues you mentioned.</p>

<p>Most US hospitals also have a suggestion form you can fill out when you think something should be changed, so use that process.</p>

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<p>Are you sure this is common to all hospitals, or is it just the one you work at?</p>

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<p>I’m pretty sure that’s not true. Hospitals are evaluated on their quality control procedures frequently, by regulatory agencies, by insurance companies, and by magazines/newspapers, etc.</p>

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<p>In my birth country, hospitals – even the public ones – stressed their ISO certifications and all sorts of organisational awards. They were run really efficiently. I don’t think it was coincidence that the government – far from being socialist – could afford to sponsor public health for low-income families with low-copays and still rack up large budget surpluses. (As I recall one year, the budget surplus was over 1000 USD per capita.) The private hospitals had tremendous pressure to compete with fine public institutions.</p>

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<p>They don’t appear to have much of an incentive to improve themselves or compete.</p>

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<p>I also have friends who work in similar places. Now, the American ones don’t see anything wrong I guess – but I actually know a specialist (of the same birth country) who’s actually on exchange. He tells me the work ethic is so much different.</p>

<p>So sometimes I have a guess at where our tax and insurance dollars go to …</p>

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<p>Well I’m not a fan of the current US Healthcare system, but if you have a screen name involving the word “French” and you’re going to criticize America’s work ethic… I predict a backlash, my friend.</p>

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<p>I’m not from France. I simply have Coldplay posters in French that inspired my username. (one for the release of Parachutes reads “le groupe qui pourrait bien bouleverser le visage de la scene anglaise”). I like cultural exchange, you see. It’s my fetish.</p>

<p>Now, if you suspect anything, my birth country is one of the Asian Tigers. It’s not relevant however.</p>

<p>Why should institutional reform be so difficult? Especially in these days of the internet.</p>

<p>Videos can be used to make “in person” announcements in place of meetings that consist entirely of one-way dialogue. So much time could be saved. (And then the actual meetings could consist of collaboration or 2-way dialogue or whatever.) </p>

<p>etc. etc.</p>

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You say that like it’s a bad thing. I had three surgeries in 2008 - 2009 and the hospital stay where I had a roommate was by far the worst.

Sometimes … but not when you’re sick and miserable. And American hospitals rarely keep people long enough to “socialize” anyway.
Seriously, if the hospitals are so darn great in your birth country, why don’t you go on back there?</p>

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<p>I was hospitalized for a few days when we lived in London. For the first 3 nights I was in a ward with about 6 others. It wasn’t too bad. Then, I was transferred to a ward where there were at least 15 patients. It was horrible. There was an elderly woman who cried out every 15 minutes “Marjory, Marjory”. The nurses would rush over to quiet her “you’re in hospital, please be quiet”. This went on all night. I got no sleep. Neither did anyone else. I was lucky that I was able to go home the next day. I don’t think I could have stood spending another night in that ward.</p>

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<p>Your comment, “why should institutional reform be so difficult? Especially in the age of the internet?” is ridiculous. The internet has NOTHING to do with hospital procedure and reform. Believe me, I have worked in process improvement in hospitals. You could make some peripheral ties, I suppose, but changing the flow of work, the payment and incentive system, etc. are incredibly complex. Not saying that there isn’t room for improvement (I think there is a lot), but I think you are probably pretty young and inexperienced and naive about what it takes. Like I said, take a stint in hospital administration for five years, then you have some room to criticize and suggest.</p>

<p>I suspect that you came to this country for your education, and possibly are getting your internship or licensure experience in one of our hospitals. I am not generally of the mindset to send people from foreign countries back to their origins, but I do think you come across as pretty ungrateful and critical to the system that is teaching you what I assume will be your trade.</p>

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<p>Not only do sick people not need to hear other people crying out, or moaning, or God forbid, rushed out with a Code Blue, or see them dying, or even if curtained off, rolled off with the head covered, but many people are queasy about seeing some of the wounds, etc. I had surgery many years ago and the rooms were semi-private (2 to a room) except on my floor, where they were all private (I asked for semi-private because of insurance restrictions, but they paid anyway, because there were none.) I was in head and neck oncology floor and some of the disfigurement was horrific, so it was better for the patients not to have someone turning in revulsion or fear, or experience the pity. The nurses even were rotated out every 6 months because it was hard on them, the nurse told me. So it makes sense in many cases.</p>

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<p>Was Coldplay a French movie?</p>

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<p>Whoa boy!!! Where to start. </p>

<p>First of all, much in the US is ratings driven these days, which is why every single consumer exchange wants you to ‘rate the experience’ for special incentives or whatever. Hospitals are no different, and on my floor, we live and die by the post discharge ratings. Negative ratings in any one area, ie, ‘noise at night, was your pain satisfactorily controlled,’ and a host of others, result in plans to work on that particular problem, either unit based or hospital wide. Quality control, and working towards excellence is a constant, and constantly evolving process. </p>

<p>Regarding private rooms, it is touted as a patient satisfier, and my hospital has added new space to make this possible, at great expense. It is the standard these days, and expected by much of the US population. I sometimes miss the old semi-private rooms, as there could be a camaraderie developed during a stay that was a delight to walk into. However for the most part, sharing a room is not fun, hearing the functions on a commode just a few feet from your bed, the conversations about pain at 2 AM, the very private family, health history and diagnostic discussions that are now looked at more stringently due to HIPPA. Some of this as well, is that being an inpatient in a US hospital these days, you’re usually quite sick. </p>

<p>The US medical system is in a process of transitioning to computerized files and so on. At my hospital all old records are now on line. This process is in various states of completion, depending on where you practice. </p>

<p>Hospital staffing is a carefully honed system, and there is not much idle time from one unit to the next where I work. If it is slow, someone goes home, or resources are shared between units. Slow is usually not a problem though, and we deal with that by having extra staff available for high need times. </p>

<p>I’m sorry you might have seen a less than efficient hospital in the US. Others, and mine was voted one of the 100 best in the country, work very hard in a multitude of areas to function in both a cost efficient and compassionate manner. </p>

<p>Cultural exchange and comparison is my passion as well. While my dad lay dying in a SE Asian country, I was very interested to watch what went on. There were great things, there were inefficiencies there as well, in a very high standard hospital. I could have come in and changed a few things around there too. But essentially, I was grateful for the care received. My wild guess is that you’re from Singapore, where efficiency is a high art, and there are not the wildly fluctuating resources and cultures of the large land mass of the US. Looking at any place with the wider lens of historical and cultural perspective elicits a little understanding of how things developed. Not that they don’t need to change, but starting with compassion can be a helpful first step in instituting that change.</p>

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<p>When I was a very young child.</p>

<p>I consider myself half-American. I regularly criticise things in either country. The third culture kid is never satisfied…</p>

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<p>Because I’d like see this one improved. But when I grew up (as a primary school student) in my birth country, my hospital (a university hospital) was a 5 minute walk behind my apartment block. I actually regularly visited for the food sometimes – which gasp, being staffed by independent hawkers (and not say, ARAMARK), was actually good. Anyway, I somehow befriended much of the staff there, and got a vibe for how much of the place worked. Of course many of the practices were common to the public hospitals throughout my country.</p>

<p>Beds can be modified based on situation. 4-6 beds per room is the usual optimum. Even 2 would double capacity. It is the ability to give luxury based on spending power – you can pay extra to get a single if you don’t need one – that allows the public to subsidise high-standard low-income healthcare in the first place. And of course doctors can determine if you /really/ need that single. My birth country had a very robust system for doing this…</p>

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<p>Um, mine was ranked among the top #100 too. It was one of the top 15 teaching hospitals.</p>

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<p>That’s one thing a federal government is supposed to do. Standardise things. Reduce institutional inefficiencies. Not force everyone to buy overpriced insurance…</p>

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<p>Intensive care units are a different story.</p>

<p>But even then, you can give people privacy without enormously wasting space. Insulating walls and boards that can be raised or lowered at will.</p>

<p>I also note that massive inefficiency comes from simple placement of healthcare facilities. Hospitals in the suburbs or more rural areas are often located well away from the center of mass of that region. In the New England town (pop: 30,000) where my mother works for instance, the hospital is so far away it is found in a forested area(!). All for cheaper land, which is a long-term expense. The result is the peripheral construction of many low-capacity facilities rather than a high-throughput facility (at nearly the same average travel distance) that makes it easier to pool resources and reduces inefficiency. That would healthcare costs and therefore, insurance and public expenses, down. But I suppose most American govts (local to federal) would rather run an inefficient social security system than invest in efficient urban planning.</p>

<p>I mean, my birth country was a massively underdeveloped country in the 1960s. Not like Virginia. Well, except maybe for hospitals serving black people (yay for the Byrd Organisation…). You’d think in that time if we a poor nation could have afforded very efficient urban planning, Americans would be capable of it too.</p>

<p>I understand it is difficult to reform institutional cultures that make healthcare expenditures (public + pvt) on average 2-4 times more expensive than developed countries with similar or higher life expectancies. But maybe someone should think of them??</p>

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<p>“And sometimes, social interaction is good.”</p>

<p>Yes, when such socialization does not involved sharing drug-resistant germs, like MRSA, C difficile and the new monster which has been popping up in the hospitals all over the world - NDM-1 bugs (I suggest reading up on this topic).</p>

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<p>It’s galoisien… Everyone back away. :)</p>

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<p>Yet another reincarnation?</p>

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<p>Hmm, elementary school observations of hospitals in another country (not even as a patient) being used as a basis to retool the US hospital system after (as far as I can tell) limited experience in one US hospital.</p>

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<p>Nurses can’t leave their units to help another unit by policy. Every nurse has a certain number of patients, and this is normally a negotiated thing.<br>
The government is pushing for hospitals and physicians to computerize. If they don’t computerize in a certain number of years, their medicare reimbursement will go down. Pharmacies have been computerized to some extent since the 1980s.<br>
There are a number of off the shelf computerized record programs available. It’s just that many in the healthcare community have been reluctant to embrace it.</p>

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<p>Someone on this thread might want to consider going back to his/her country of birth if things are so much better there …</p>