Sunday, July 17, 2005


Got back from China, promptly found myself facing a medical hiccup (not related to my travels, but that's another story). Some observations after about 2 weeks in one of the country's top-ranked hospitals:

Undeniable expertise and skills. The doctors and nurses alike are very well-versed in their craft, aggressive in asking questions, and willing and able to use state-of-the art technology. Yet all of that investment in training and expertise, and in technology, is undermined by the failure to do the little things. Orders repeatedly failed to be transmitted down the chain of care. The standard of hygiene doesn't match that of a budget hotel. Equipment was in poor repair, as were basic items such as hospital gowns.

Diagnosis: Our technology-obsessed culture has crowded out the basics. Top hospitals are in an arms race to have the most cutting-edge gadgetry, and to recruit personnel with the fanciest credentials, but I believe they are at the point of zero marginal return on that investment, because they are failing in two basic ways: Internal communication is lousy, and there is no awareness of the importance of the basics.

Prescription: 1) Invest some of the technology budget in electronic patient management, so the nurses don't have to read the minds of the doctors; and, 2) Invest in the basics. Floors, restrooms and the facility in general should be clean; the food should be edible; gowns should not be full of holes. If it takes aggressive retraining of staff, and invesment in a few more staff, it's worth it.

Believe it or not, simple environmental factors have a huge impact, both physically and psychologically, on patients' outcomes. Why doesn't our medical establishment recognize that?


Blogger Other Lisa said...

Carlos, hope you are okay!

Well, first off, you have to pay the custodial staff decent wages, and I would bet for the most part, that isn't happening. They probably sub-contract to companies that use a lot of undocumented labor and they pay them for sh1t. And they are probably, as you say here, under-staffed.

But you know, our entire medical system is a mess. Admin costs take up over 40% of total costs, last time I checked into it. This is no way to run a health care system. I really believe that we need some kind of national health INSURANCE (not "socialized medicine"), where forms are standardized, which alone can save a lot of money. Some big businessmen types are starting to get this, and I'm surprised that it's taken this long and that there aren't more of them. Individual taxpayers and corporations and businesses above a certain size should pay a percentage towards funding this national insurance fund. Everyone would save a ton of money, and I absolutely guarantee you that we could create a better quality health care system than what we have now.

Considering the deficiencies in your quality of care, can you imagine how the uninsured are treated? And that is a huge number of people. 40 million, I believe...

Anyway, I hope you are feeling better!

July 18, 2005 10:39 PM  
Blogger Carlos Zapato said...

While I agree with some of your thesis, I would point out that I was in the UC system. All the staff are union, and better paid than at many of the private hospitals. I am convinced that the problem is cultural, not economic. The management simply aren't conscious of the importance of the environment on well being.

July 19, 2005 3:31 PM  
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