Healthcare Quality is Diligence, Thoroughness and Attention to Detail... Learn How to Find It.

hello this is Dr Eric Bricker and thank you for watching a healthcare Z today's topic is healthc Care Quality is diligence it is thoroughness and it is attention to detail now I've been talking to a lot of doctors and quality experts and employers and broker benefit Consultants a lot about Healthcare quality recently and I think that Health Care Quality can be boiled down to diligence because Healthcare is a service and really to provide a highquality service it requires diligence now this is not an Eric Bricker idea this goes all the way back to Dr William Osler who was the founding physician of the Hopkins Department of Medicine over a hundred years ago in the early 1900s now this is a picture of him right here now Dr William Osler wrote a book or rather a book was written about him called the quotable oler so it's a whole bunch of William oler quotes I did my residency at Hopkins and all the medicine res residents are given this book when they finish their residency and guess what Dr William oser over a 100 years ago had this to say about diligence and Healthcare quality I'm going to read you a few quotes one by far the most dangerous foe we have to fight is apathy indifference from whatever cause not from a lack of knowledge but from carelessness from absorption in other Pursuits from contempt bred of selfs satisfaction next quote The Killing Vice of the young doctor is intellectual laziness and finally maintain an incessant watchfulness lest complacency be get indifference or less local interests should be permitted to to narrow the influence of a trust which exists for the good of the whole country that's right over a hundred years ago Dr William Osler said that apathy was the worst trait a physician could have accordingly a la a a complete lack of apathy a complete obliteration of apathy a complete elimination of apathy is diligence and there's a huge culture of diligence within John's Hopkins so it's even referred to as being oserian Hopkins has an osian culture amongst the nurses amongst the respiratory therapists and the physical therapists and the doctors where look everybody was kind of expected to be diligence and if anybody was kind of like slacking off everybody else kind of like look around like why you slacking off you can't slack off that's not what we do here we don't we're diligent around here so there was really a culture of diligence now I will say that other places where I've worked in healthcare it was kind of spotty okay there were like pockets of diligence but it wasn't really uniform throughout the organization and that's another video for another day okay now note what is not Healthcare quality what did William oer not say Healthcare quality was it was not measured via outcomes okay because at the end of the day of course you have some patients who are incredibly sick they have an incredibly Advanced disease and you can be as diligent as humanly possible and at the end of the day they may have a bad outcome now every doctor knows that if you want to you know quote unquote have good outcomes the best way to do that is to cherry-pick your patients to only have the easiest paces and to lemon drop your worst patients your most complicated patients the the patients with the most advanced disease the most the patients who are the most who are the least adherent to your advice or to taking uh medications right so really I if you're measuring by outcomes all you're really measuring is the doctor's ability to cherry pick and lemon drop and that's not what you want you want to measure their diligence okay we also because we're talking on a healthc care Finance channel here compensation should be should promote diligence okay so listen you can have whatever compensation structure you want but I would argue the end goal of that compensation structure is to promote diligence now fee for service by en llarge the major form of compensation for doctors here in America I would argue promotes rushing and rushing is not diligence because if you the more patience you can see the more you can build and the more money that you can make and so if you can see patients if you spend only five minutes with a patient instead of 15 minutes with a patience then you are financially rewarded in fee for service that does not promote diligence okay now of course here on a healthcare Z we have to have a 2X two Matrix so if you're going to apply this framework of diligence to a population then here what we have on the top of this 2x2 matrix is high clinical complexity or seriousness which would be something like major surgery like a like a spine surgery or he a knee or a hip replacement cancer cardiovascular disease I'd even put complex OB in here as well whether it's complicated for the mom or complicated for the baby okay so you want and then over here on the side we have diligence so you want a high degree of diligence with a high degree of complexity okay now now what's the exact opposite of that well when you have low diligence but you also then have low complexity you might just have an upper respiratory tract infection you got a runny nose or Etc so like okay maybe you need a covid test maybe you need a uh a strep throb maybe you need a a flu a flu test okay so fine like not hugely complicated okay so you don't necessarily have to have the most you know the greatest diligence in the world for addressing that and that's totally okay because we have to stratify our resource allocation our diligence um allocation right it's totally okay but what you really don't want to have is you don't want to have a very complicated situation with low diligence you don't want to have major surgery cancer cardiovascular disease high-risk OB in a low diligence environment with low diligence doctors and low diligence nurses okay you don't want that okay and then likewise you actually don't want High diligence with low complexity in other words you don't want to have a huge degree they used to have this at the outpatient clinics out in the suburbs of Hopkins where all of the outpatient doctors would come in and be our attending in the hospital every once in a while and they'd be like yeah look my clinic is mostly just the worried well they're coming in and they don't really have a lot of complex disease their dis diseases they don't have that many chronic diseases their dis diseases aren't that advanced but so like that's not good either because there's an opportunity cost so here you have all these incredibly diligent people people who are not necessarily treating the most complicated situations so listen you've got to be able and I have another video about mismatch between providers and disease and I'll leave a link in the show note to that provider mismatch video where I go into this in much greater detail okay so so fine what is what is practical information that you or employee health plan members can use okay so it's very difficult for a patient to like ascertain the diligence of a physician one of the things that they can do is if they go to a primary care physician first a primary care physician probably has a lot more knowledge of the local other providers in the area and it's going to have a better understanding frankly of where that diligence is for your particular situation so if if anything you're almost looking for the referral expertise of that primary care physician um as part of that service that they're going to provide for you and then also too like a navigation at our old navigation service Compass Professional Health Services that's what we did all the time like we spent like literally all day long we were identifying the highly diligent Physicians and then we were talking to our members and figuring out if they had high or low complexity medical situations and then we were matching up we would get people with a new cancer diagnosis like almost daily ATC compass and we're like look you know what what you know what whatever wherever you were located in the country Etc it's like okay what are the various criteria that we're going to use to identify those High the high diligence surgical oncologist uh medical oncologist etc for that complex situation now your own experience as a patient can also be helpful in assessing diligence and I call them the three don'ts listen if the doctor doesn't listen very well if they don't explain things to you very well and if they don't wash their hands in front of you then they are probably not diligent to say that in the affirmative I have seen highly diligent quote unquote high quality doctors almost always be very good listeners explain in detail what's going on to their patients and by all means wash their hands in front of the patients so it's not perfect but if you have a doctor who doesn't listen well doesn't explain things very well and is not washing their hands in front of you then like you just need to vote with your feet you need to find somebody else so I think the issue of healthc Care Quality while it may seem complicated can actually be boiled down to diligence and thoroughness and attention to detail and that's what I wanted to share with you today thank you for watching a healthcare Z

Channel: AHealthcareZ - Healthcare Finance Explained

Views: 2,080

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Id: VHJQAUYwigo

Length: 9min 44sec (584 seconds)

Published: Mon Jan 22 2024