Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
Readers Write: The Journey to Value-Based Care: Lessons Learned from Aviation
The Journey to Value-Based Care: Lessons Learned from Aviation
By David Nace, MD
The Affordable Care Act (ACA) and healthcare reform have impacted providers in all aspects, from the way they are and will be paid to how they engage patients. To meet the deadlines and demands of an industry shifting to value-based care (VBC), physicians must change their thinking from independent to team-oriented in order to succeed in this new world.
VBC is empowering an evolution within the overall healthcare community, especially amongst physicians. This is enabling a focus on delivering high-quality of care to patients. The Meaningful Use and EHR certification programs have helped all provider organizations get closer to the more meaningful use of information technology, but the requirements also pose many challenges for providers.
These challenges should not be met with resistance. The physician community should embrace the call for change. Similar to the revolution of the aviation industry, reform required them to adapt to new methods of communication and technology to ensure safer flights.
Traditionally, physicians are independent and competitive in nature. They didn’t go through rigorous selection and testing over nearly eight years of higher education to merely coast by – they have an innate drive to be successful and help people. Value-based care, in theory, plays to their personality traits and gives them the motivation to achieve even higher goals.
However, physicians have a hard time trusting data or measures that they do not understand, especially when their evaluation is out of their control and input. For example, a 2014 survey of 4,000 physicians found 78 percent reported patient satisfaction ratings moderately or severely affected their job satisfaction and 28 percent considered quitting their job or leaving the medical profession.
To add to this statistic, most organizations do not have the appropriate communication, technologies, and data collection sources and processes put in place to understand the measurements being imposed on them. To tackle this challenge, hospital executives and physicians need to improve physician communications and transparency in regards to measurement.
Pilots faced a similar disconnect during the 1980s. Training a pilot occurred in an apprenticeship model — you learn from a “master” and through them learn their personal techniques and strategies. It really was a “master craftsman” mentality of mentorship.
This method of training and learning lead to a variations in practice and high accident and death rates associated with aviation. The practice was not based on teamwork or leveraging technology for standard operating procedure. There were no Global Positioning System (GPS) and Cockpit Resource Managements (CRM) utilized – it was all based on the techniques and approach of pilots. To understand the technologies imposed on them and to improve quality of flight, the way pilots were taught changed to a team-based approach that focused heavily on communication and transparency, data, and standard operating procedures.
There is a similar revolution coming to the world of medicine. Many of the physicians of tomorrow are beginning to prepare through team-based, information driven training. Young physicians in training are being proactive in understanding the methodologies and technologies of today and starting grass root movements — for instance, Primary Care Progress — to inform and inspire newcomers to the industry. Medical students are increasingly being trained in groups (versus one-on-one) to leverage the concept of teamwork and to better understand the evolving healthcare industry and their role in the transformation.
Change is inevitable in any organization. New rules, methods, and technologies will always cause a shift. These transformations should not and cannot be met with resistance, but with an open mind, as everyone needs to work together toward the end goal.
Pilots needed to adapt and alter their training and methodologies during flight to fly in a safer, more efficient manner. Similarly, providers must do the same with value-based care. The more collaboration, the smoother the ride will be.
David Nace, MD is vice president and medical director of McKesson Technology Solutions.
But the government does not get involved in what meaningful use of onboard flight instruments are…they let the pilots and technical folks determine what is the safest most usable and efficient methods for flying. Right now we have EHR vendors that ONLY care about certification of their Meaningful use products and could care less about efficiency usability safety or security. So we have a huge disconnect there. Plus patients are NOT customers. The doctor patient relationship is more like a student teacher relationship, it is uneven on purpose, there has to be trust and connection and an overriding purpose to do what is RIGHT not want the customer wants, and we are not on an even field on purpose. If we paid teachers on what students’ satisfaction scores, every teacher would give out all A’s and no homework and goof off all day. Same with physicians, to have patients grade satisfaction could cause physicians to give unnecessary tests on patients requests, boatloads of narcotics, or other things to satisfy the patient but completely unsafe and unnecessary. Be wary of the 5 star hospitals and doctors. There are times you cannot give the quadruple bypass patient more pastrami for lunch or their pick of high power narcotics or not telling them they are actually too fat for surgery. There is a BIG misconception that patients are customers. They are not. They are patients and we are doctors. Sure there is some need for feedback but not everyone will be satisfied. I also feel if we are doing payment by satisfaction scores, then we should rate EHR vendors, CMS for their ability to answer claim questions and support providers and patients, Congress on their scores, if they are all lower than 5 star, then they ALSO get a 30 % pay cut. Only seems fair. Again be wary of comparing medicine to other industries, it is unique and its about time people realize that.