Its been more than seven years since a landmark report from the Institute of Medicine provided a jarring wake-up call to Americas fractured healthcare system.
Since the IOMs 1999 release of To Err is Human: Building a Safer Health System, however, the absence of any dramatic progress has created a sense of frustration and anxiety among many of the systems most important playersthe physician-executives who direct and provide care to patients. Indeed, the disenchantment is laid bare in a new national survey of nearly 1,200 physician-executives that asks about the hurdles these practitioners face in improving care for their patients. The survey, conducted by the American College of Physician Executives, includes a focus on some of the most sensitive topics in healthcare today, producing potentially shocking responses.
Safety and quality is on the radar screen, but decisions are financially driven, wrote an anonymous physician in one of hundreds of personal responses to a query asking about obstacles faced in the effort to improve the quality of care. Another doctor expressed a common theme that ran through much of the survey: Right now, physician income and hospital revenue are driven by volume and proceduresnot quality, appropriateness, necessity or outcomes.
All told, the survey underscores the need for drastic change, observers say. In one section, about 60% of the physician-executives answered yes when asked if they have struggled with finding an appropriate balance between what you believe is best for patient(s) and whats best for your healthcare organization when it comes to implementing quality/safety initiatives. Only about four of 10 respondents said they did not grapple with that dilemma.
Before you can fix a problem, youve got to face the brutal facts, said Steven Tremain, an ACPE member who is senior medical director of Contra Costa Health Services, Martinez, Calif. This survey is part of the brutal facts.
Its troubling, added Barry Silbaugh, immediate past president of the Tampa, Fla.-based ACPE and a consultant on patient-safety issues. I think this reflects that many physician-executives have real concerns about this area. Neverthless, current ACPE President Chalmers Nunn said that physician-executives can provide a road map for solving the problem through personal and professional development (See Commentary, p. 20).
In general, the new survey focuses on the various obstacles that many doctors believe have hindered improvement in patient safety:
One of the questions addressed an age-old dilemma: In your healthcare organization, are there situations where low- or poor-quality (care) is tolerated for physicians or departments that generate high amounts of revenue? About 39% of the respondents answered affirmatively.
Thats a significant percentage that highlights a serious problem, said Paul Ginsburg, president of the Center for Studying Health System Change. But, Actually, I was somewhat encouraged by the fact that 61% said No, Ginsburg said. A casual reader might be shocked by the fact that 39% say this happens, but I know that organizations do this.
Results and comments will be published in the May-June issue of the ACPEs Physician Executive.