Sunday, July 15, 2012

WWAD? (A=Atul)

The sad story of Rory Staunton, the young boy who died of sepsis infection, has been prompting a lot of commentary.  I have noticed that is the nature of press coverage that it often takes a sympathetic figure to get attention to a long-term, systemic problem in the health care system.  I have written here of the efforts of Dr. Jim O'Brien and others at the Sepsis Alliance to help doctors and nurses learn of the early warning signs of a sepsis infection.  Let's hope that the recent story will give a greater impetus to the expansion of training about this important clinical problem.

But it is not of that topic that I write today.  Instead, I would like to explore the obligation of the dominant health care provider in the region to become a force in reducing harm and improving quality and safety in its own institutions and beyond.  I am prompted to do so by a banner advertisement that accompanied Maureen Dowd's story today about Rory Staunton.  Here's the ad:

When you see an ad like this accompanying such a sad story, you are tempted to click through to actually see how "Partners is changing health care for the better" with regard to the types of issues elicited in the story.  What do we find?

Well, not much about the topic at hand.  While some other stories are included, a pervasive theme seems to be about cost.  Also, part of the messaging is meant to undermine reports done by the state's Attorney General about the disproportionate level of rates received by this provider group:

I don't mean any of this to suggest that this provider group is not trying to provide excellent care.  I know many of its doctors and nurses and have found them to be impressive and well intentioned people.  It just seems that this provider system is so intent on messaging for political purposes that we don't get to learn what they have done about the kind of misdiagnosis and mistreatment seen in the Staunton case, or for that matter what they have done to eliminate harm in other settings.  After all, there are many impressive and well intentioned clinicians throughout the United States who still collectively represent the fourth or fifth ranked public health hazard in the country.

I have noticed that the media in this city gives this provider group a bye on these issues.  Perhaps the reporters are so busy covering legislative debates on cost issues that they don't have time or inclination to see what's being done--or not being done--to stop killing and maiming patients.

So, here's my suggestion to enterprising reporters.  Let's consider who in Boston is most associated by the public at large with ideas for improving the quality of care.  Among that group is clearly Dr. Atul Gawande, a physician in this very provider organization, who has done superb work in this field.   A reporter might compile a list of  the major conclusions in Atul's books and articles. Then, the reporter could take Atul's recommendations for improving the quality of care delivery and see the extent to which they have been adopted by his hospital and by the entire health care provider network in which he works.

Several years ago, I noted:

The Partners hospitals are full of well intentioned, dedicated people. But there has not been a corporate public commitment to reduction of harm and to transparency of clinical outcomes that could help build broad public confidence in the quality and safety of patient care.... Ironically, some of the world experts in these matters are faculty members in his hospitals. The Partners system should be a world leader in the science of health care delivery, along with the fields in which it already holds prominence.

I'm not saying all of Atul's ideas are necessarily the right ones for all organizations, but should not the major provider group be held accountable to show how they have implemented his ideas, or if not, why they have not?  Who knows?  There might be some good news on this front worthy of publicity.  If so, perhaps future banner ads will click through to more relevant success stories.


Bart Windrum said...

Paul, the nature of hospital advertising is something I delved into during and after my parents' hospitalized deaths. You may recall part of my patient-family story: Dad acquired nosocomial fatal MRSA in a Jayco 100 facility, at which 2 banners flew. One in the cafeteria proclaimed the place as a best place to work according to some magazine. The more egregious one touted the Jayco 100 label. It hung, large as a billboard, suspended near the roof off the side of the building facing the 6 lane thoroughfare/highway. It served as a billboard. Dad also went without food and watering or other assistance there due to insufficient nurse monitoring; I had to hire and pay out of pocket for nightime sitters (had I known better then I would have tried to arrange for a recliner for myself in his room).

As I wrote my subsequent book I included the thought that a hospital that flew a banner proclaiming "We Forecast Early and Often" would become a candidate for my business (I don't know which doctors would feel likewise).

All of us can immediately assess when advertising and other messaging is self-serving. Too often.

Anonymous said...

I think advertising can have a particularly inimical effect in health care, where the knowledge and tools for patients (I hate the word consumers) to make their own judgements is largely absent. Witness the recent full page ad in Business Week by Penn Medicine for proton therapy for prostate cancer. One commenter noted that such ads should have to include complications and side effects like pharmaceutical ads.

One wonders whether such advertising may eventually be regulated more strictly - personally I think it's already overdue.

nonlocal MD

Peter Yang said...

I too was very saddened by Rory Staunton's story and agree that reinforcement about clinical triggers/checklists may decrease the chances of these cases.

With regards to advertising, it's important to remember that Partners did not specifically choose to advertise on that page. Rather, there were keywords or site-specific criteria on the page that matched up with what Partners purchased from the adserving company that served up those advertisements.

My main medical center is not part of the Partners network, but I have been involved in one of their quality improvement projects. They actually struck me as having a strong dedication (in terms of both human-hours and dollars spent) on improving their adherence to many quality and patient safety-related outcomes, and I've had the privilege of seeing first-hand improvements come about from their initiatives.

Nevertheless, since it's not as sexy as some other fields which may generate more impressive headlines, quality improvement may yet still play second fiddle. However, I believe that QI offers--using a term that some groups care very much about--good return on investment, and that its importance will continue to be more greatly appreciated moving forward.