Healthcare: realities vs. wishful thinking

Imagine that you or your loved one need to spend a few days at the hospital. Naturally, the quality of care becomes your paramount requirement.?

Let us look at how the health care system responds to your needs. First, you are likely to spend hours in an overcrowded Emergency Room (ER) - most of the ERs around the country are overcrowded; while your relative (we strongly recommend that you have one with you) is attempting to get the attention of the nurses and physicians moving around, trying for a long time to find out why you are in pain or have a fever and what should be done about it.? This is not an easy task as all nurses and physicians are very busy taking care of other patients.? Then, you have to wait for a few hours for a CT scanner to free up as your physician, whom you eventually met, said that you need it. Finally, after you spend many hours (sometimes over 24 hours) waiting, you are admitted to the hospital.? Then, you are trying to get the attention of your very busy nurse while doing your best not to annoy her with your questions/requests. This grim but absolutely realistic picture could be continued on and on. Let me ask you then what would be a satisfactory level of care that you would like to receive?? Suppose that you have a nurse available and a doctor that takes care just of you and only a few other patients, a CT scanner that’s available to you in a matter of minutes rather than hours, etc. Wouldn’t this be great?!? So why don’t we get to experience this? The answer you would receive from many health professionals is that we have to spend more money building more beds (each for $1.5-$3 million in capital costs and over $0.5 million in annual operating costs), hiring more nurses, physicians and buying more CT scanners to match patient demand and hospital capacity. ?Why don’t we do this then?!? The reason is simple – we cannot afford spending more on top of our $4.9 trillion health care dollars a year. Besides, even if we are willing to increase our national debt ceiling, we still cannot recruit enough physicians and nurses to meet current peaks in patient demand. Thus, we simply cannot afford to balance hospital supply and patient demand to make our hospitals less overcrowded. End of the story? Not necessarily. Average US hospital bed occupancy is 65-67 percent, which is less than in any other industrialized country.? On average, one third of the US hospital bed capacity is idle, and yet, we are overcrowded!? Doesn’t this sound irrational? Welcome to US Healthcare. Why do we experience this phenomenon? The reason is that utilized hospital capacity is highly variable, fluctuating on a daily basis from peaks to valleys. You are lucky if you are admitted during a valley, and you are very misfortunate if you get in during a peak in patient demand, when all hospital resources (beds, nurses, physicians, radiology equipment, etc.) are stretched thin. This very gloomy scenario seems inevitable. Indeed, what can hospitals do when patients arrive in clusters?? Let us ask then: -Why do patient arrive in clusters on a particular weekday?? Do they break more legs on Thursdays than on Tuesdays? This does not seem to make sense. Indeed, at almost every hospital, there are particular weekdays when it regularly experiences an influx of patients. Why do they have these Mondays- or Wednesday-related “epidemics”?

The answer is in so-called health care “culture”.? Contrary to the common sense, the main cause of peaks and valleys in patient demand are not patients coming to the ERs but … scheduled (planned) patient admissions!? At many hospitals it might be literally easier to predict when someone breaks his leg and comes with an ambulance to the ER than when a planned surgery takes place.

With historically excessive health care resources, it was acceptable to have as many planned surgeries or catheterizations as a doctor could want to do on a given day, thereby creating artificial peaks in “patient” demand.? In the past, excessive resources (operating rooms, beds, nurses, etc.) have always been available on demand.? Not anymore. And yet, these artificial peaks and valleys continue to be the consequences of the health care “culture” that endangers patients, makes health care costs unaffordable, reduces access to care and puts artificial pressure on clinicians.? If you are in a hospital bed and push the button to call a nurse, and one does not come, this is not necessarily due to the shortage of nurses. Your 5-10 hours waiting in the ER to be admitted are not necessarily the result of a hospital bed shortage. When your nurse, who is taking care of eight patients instead of recommended four, provides you with a wrong medication, it is not because the nurse is mean spirited. All of the above are the results of these manmade peaks in hospital occupancy.

These artificial peaks and valleys in utilizing hospital resources can and should be smoothed. We do not have to choose between spending borrowed health dollars and saving human lives. There is a practically proven methodology that allows having simultaneously safe and inexpensive health care. Every hospital (e.g., Johns Hopkins, Cincinnati Children’s, Mayo Clinic, FL, Toronto General, etc.) that has applied it improved quality of care and achieved multimillion annual cost reductions with simultaneous improvements in patient safety, patients’, clinicians’ and hospital managers’ satisfaction.? This means providing an adequate health care with existing resources and saving tens of billions dollars annually nationwide, as described in a recent book by Mark Taylor.? Indeed, by properly managing patient flow Cincinnati Children’s alone saved $100 million in avoidable capital cost for not building beds to accommodate men made patients influxes and over $100 million annually. If each of 6,000 US hospitals does the same but achieves (very conservatively) only 10% of these financial results, it would mean $60 billion in avoidable capital cost plus over $60 billion annually. If every hospital avoids building just one extra bed needed to accommodate artificial patient influxes, this would mean saving $9-18 billion in capital cost alone. These numbers represent the waste that is intrinsic to the current health care delivery. We need this money to give a new lease of life to Medicare, etc. Most importantly, we need to properly manage patient flow to reduce the current, intolerable number of medical errors, thereby saving thousands of human lives needlessly taken by our health care delivery. Using this methodology, The Ottawa Hospital was able to save 40 lives annually. If each of the 6,000 US hospitals achieved only 10% of this, 24,000 lives would be saved annually.

Given the steadily increasing patient demand, unless we confront healthcare “culture”, our destiny is overcrowded hospitals, unsafe care, nurse shortage and growing health care costs that ruin our economy.