How much can we standardize medicine, and even if we can, is that a good thing?
There was a meeting yesterday for all of our Ambulatory Care Network to bring the directors of the multiple practices together, to find out what we could standardize across the practices, what made sense, what was feasible, what might help, and what might be good for patients, providers, and the regulatory requirements that weigh so heavily on our shoulders.
During a recent institution-wide Joint Commission Mock Survey, one of the many comments that were received from the surveyors was the apparent lack of standardization in how we do things.
From site to site, practice to practice, how packages are received and processed, how supplies are stored, how patient identification and verification is done, how facility administered medications are given, seemed to vary so much, that it apparently seemed to the surveyors that each practice had made up their policies and procedures on their own.
The leadership, in reviewing these comments, had decided that it was worth looking at all the things we do across all of our practices, and perhaps try to standardize things. To try and ensure that patients moving from one practice to another get the same experience on the phones, at registration, with nursing, with their providers, with every interaction throughout our healthcare system.
The question I have is, is this a good thing? Ever? Always? Never?
Standardization in healthcare can certainly improve efficiencies, decrease errors, improve patient and provider experiences, but at what cost?
Where do we put the standardization in, where do we enforce it, how much leeway are we allowed, and are we always sure that standardizing makes things better?
Look at all the good that has come from “Sign Your Site,” surgical checklists, and timeouts in the OR. It is clear that these things have prevented patients from getting the wrong body part removed, making sure that the right medicines and implants are available at the time of the surgery to prevent delays and complications, even that it is the correct patient on the operating table.
I recall seeing one of my patients in the hospital the night before she was scheduled for amputation of her leg. As I got ready to leave, she grabbed my hand and said “Dr. Pelzman, please make sure they remove the right leg.” I told her she needed to say “the correct leg,” since in fact it was her left lower extremity that had deteriorated beyond saving.
Patient verification probably prevents the wrong patient from getting the wrong lab results entered into the wrong chart hundreds if not thousands of times a day at practices throughout the country, prevents prescriptions being sent in for the wrong patient, and prevents the wrong diagnosis being given to the wrong patient more times than we can imagine.
But when it comes down to the nitty-gritty of what we do, the person to person care, we need to figure out where to strike the delicate balance between cookbook medicine and checklists with endless compliance and regulatory boxes that need clicking, and the true art of the science of medicine.
Having guidelines about how to handle specific clinical scenarios certainly makes sense, the standard “work up” is what we all look at to figure out what to do when someone is fatigued, having chest pain, short of breath, or itchy. None of us wants to miss the pulmonary embolism, the acute coronary syndrome, or the occult malignancy.
But no patient is the same, no clinical scenario is the same, and no provider wants to be told of the need to treat certain patients a certain way at a certain time for a certain set of symptoms.
None of us want the care and management of our patients dictated to us.
If standardizing and streamlining the way supplies are managed in our practice, the way appointments are given so that our patients get access to the care they need, the way follow-up of lab testing is done to ensure high-quality feedback of results to patients and prevent negligent errors, then let’s bring it on, let’s standardize the heck out of our practices.
The lessons we have learned from industry on how to improve and standardize can help the business side of things, so supplies and phones and customer service and error prevention all run like a well-oiled assembly line.
But I think we’re going to get more and more resistance as we try to encroach on the provider-patient relationship, because standardizing that means you might as well replace me with a robot.
Takes the art out of the art of medicine.
Standardization and protocols can lead to ensuring that things don’t get missed, that we know what we know and what we don’t know, but when we begin to require it, force it down the throats of providers, turn us to automatons, then we run the risk of dehumanizing this field that we all love so much.
We have higher standards than that.