Guest post by Andrew Dumit
“Lowering Health Care Costs Is Hard Because Every Patient Is Unique.” 1
This statement is not false – far from it, in fact. Yet, while it was a featured article in the Atlantic in 2013, framing this statement as the complete truth is paralyzing medical professionals from taking action.
One place where this belief has caused inaction is at local hospital, which is home to a world-class pediatric liver transplant team. My team has been tasked with lowering the cost per patient for the hospital by reducing the length of stay of pediatric liver transplant recipients, which the team at the local hospital has been unsuccessful at accomplishing. For each of the many lives saved there, a complex process must be completed, which includes three major steps: preparing the patient for surgery, performing the surgery, and preparing the patient for discharge. In the first two steps, the team has got their routine down, but the last step is where my team seeks to make an impact.
The question I asked myself was: how could relaxing the assumption that every patient is unique make an impact in the length of stay metric? To answer this question, I looked to a study done by a team that deals with adult liver transplants out of the University of North Carolina Health Care, Chapel Hill. Through their comprehensive study of their own length of stay, the team there concluded that “clear expectations, improved teamwork, and a multidisciplinary clinical pathway were key elements in achieving and maintaining these gains.”2 With this in mind, the aspect of the study that I’ll be investigating in the remainder of this post is how the clinical pathway created by the UNC team brought about tangible results by relaxing the uniqueness assumption
First, I looked at what was the thing keeping the local hospital from making similar changes to those performed in the UNC study. In the local hospital setting, the mantra that every patient is unique appears to reign supreme. Because of this, members of the local hospital’s team have been unable to take any meaningful steps towards truly changing the routine filled with miscommunication and inefficiency. By using the uniqueness of each patient as an excuse, the team refuses to treat some aspects of patients similarly. Conversely, the team in the UNC study went against the grain and tried to identify steps that were similar across patients to optimize those steps.
How did the UNC study take advantage of this relaxed assumption? Their checklist is a prime example. It sets forth the steps for each of the members of the team that must be completed before a patient can be discharged. In one way, this could be seen as homogenizing the patients and this seems to be the case at the local hospital. In fact, the current method for keeping track of a patient is a checklist unique to that patient. The local checklist is very much opposite to that of the UNC checklist, which is the same patient to patient. The reasoning behind the checklist at the local hospital seems to follow from idea that every patient is unique. However, their sparse list has not shown any improvement in length of stay, whereas the comprehensive and consistent pathway created by the team at UNC significantly reduced the length of stay.
Ultimately, in the case of the clinical pathway, if just a small number of tasks are similar patient to patient then making those tasks consistent and require the least additional effort possible can significantly speed up the process. And, if it’s true, which it appears to be, that more than just a small number of tasks are consistent patient to patient, we’ve found a truly tangible way to reduce length of stay by relaxing the assumption that every patient is completely unique.
The one thing I hope people take away from this blog post is that this is just one instance where the patient uniqueness idea has barred improvements in patient care. I don’t mean to say that we shouldn’t treat patients as unique, but I think it’s incredibly important to realize that we shouldn’t just look at patients for their differences. Instead, we should look for certain things about them that are the same and exploit those similarities to improve patient care and reduce hospital costs.
References:
- http://www.theatlantic.com/health/archive/2013/09/lowering-health-care-costs-is-hard-because-every-patient-is-unique/279950/
- Toledo, Alexander H., Tracy Carroll, Emily Arnold, Zeynep Tulu, Tom Caffey, Lauren E. Kearns, and David A. Gerber. “Reducing Liver Transplant Length of Stay: A Lean Six Sigma Approach.” Progress in Transplantation 23.4 (2013): 350-64. Web.