Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

5 steps to create medical quality without trying

Kjell Benson, MD
Policy
July 25, 2017
Share
Tweet
Share

The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” These non-providers then send threatening letters and cut salaries with “pay-for-performance.” Unsurprisingly, such efforts are not working, and only end up creating distorted physician-patient relationships. Yet, obtaining improved quality requires only a few key steps.

1. Choose strong clinician leaders. We all have had enough of MBA and PhD types lecturing clinicians about medical quality. Only practicing providers understand the difficult balancing act of the patient relationship, with its ethical duties, inherent subjectivity, and inevitable stresses. A physician leader is required to set the tone of quality as the inevitable goal of the physician-patient relationship. Find a leader who believes this deeply and is willing to have the difficult conversations to propagate it.

2. Define an ongoing consensus in your group regarding why you are providing medical care. This is not the same as a mission statement or a physician compact or any other document. A consensus means an ongoing understanding that’s renewed monthly, daily and, perhaps, even hourly. The medical profession often forgets to talk about why we commit our lives to it, and those who say, “I went to medical school in order to help other people,” are the ones you want on your team. Some others may answer, “I wanted to have a comfortable profession.” These are not the droids you are looking for. A team that understands that they are in it for the patients first, will be a team that coalesces around the need for quality.

3. Agree that medical care is a process. Perhaps this seems obvious to many people today, but if so, this is a recent advance. When I was in medical school, we learned about diseases and people, but the actual provision of care was simply assumed with some magical hand-waving. We now understand that every aspect of employing scientific tools to help one patient after the next implies an underlying process. This realization has created an entire industry of process improvement and LEAN techniques that have improved care and patient experience immeasurably. Remarkably, there are still clinicians around who have not figured this out. Avoid them.

4. Create tools to measure and visualize the process. Useful data regarding how the processes work are essential. I find that most understand this crucial step by now. Create tools, then publish and diffuse them. Everyone — and I mean everyone — from environmental services to the CEO, should see the same process data, regularly. When we hide process data we give the impression that the data reflect embarrassing individual performance and not group process. Use this tendency to conceal data as a reminder to relentlessly return to the underlying process. We unfortunately rely on individual clinician brilliance to make up for increasingly complex cases where the process sophistication has not kept pace with the care provision. Do not mistake process errors for clinician inadequacies.

5. Agree that medical care is not JUST a process. This step is listed last, but may be the most important. No one went through years of grueling training to be just a well-oiled step in a process. And the heart of quality, the heart of the quality that has meaning to most people, resides in the relationships, conversations, empathy and medical wisdom that exist outside of “process.” Clinicians burn out when we forget to emphasize this, dwell on this, and celebrate this. Doctors live for the parts of care that are NOT processes, and patients value them too. The first four steps of creating quality are designed to become transparent so that we can spend nearly all our time in this last one. A high-functioning medical group hard wires the first four steps as its baseline, and then retains excellent clinicians by cultivating everything that is NOT process: clinical acumen, empathy, continuing education, compassion, service and professional development.

Notice that none of the steps contain monetary incentives nor payer alignment nor any of these attempts to monetize quality. Focus on the five steps, and you simply won’t need so-called pay-for-performance.

Kjell Benson is a hospitalist who blogs at The Consolation of Philosophy.

Image credit: Shutterstock.com

Prev

Helping a patient can help with grief

July 25, 2017 Kevin 0
…
Next

Real grieving after suicide doesn't occur on social media

July 26, 2017 Kevin 0
…

Tagged as: Hospital-Based Medicine, Public Health & Policy

Post navigation

< Previous Post
Helping a patient can help with grief
Next Post >
Real grieving after suicide doesn't occur on social media

ADVERTISEMENT

More by Kjell Benson, MD

  • Are we medicalizing everything?

    Kjell Benson, MD
  • Quality is this physician’s religion

    Kjell Benson, MD
  • Doctors, we need to start making our own tools

    Kjell Benson, MD

Related Posts

  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • How can you determine a Caribbean medical school’s quality?

    Jerry Wargo
  • 3 steps to gain expertise early in your medical career

    Stephanie Wellington, MD
  • 6 ways to give quality feedback to medical students

    Micaela Stevenson
  • Quality measures have gotten ahead of the science of quality measurement

    Peter Ubel, MD
  • How the COVID-19 pandemic highlights the need for social media training in medical education 

    Oscar Chen, Sera Choi, and Clara Seong

More in Policy

  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • The hidden health risks in the One Big Beautiful Bill Act

    Trevor Lyford, MPH
  • The CDC’s restructuring: Where is the voice of health care in the room?

    Tarek Khrisat, MD
  • Choosing between care and country: a dual citizen’s Independence Day reflection

    Kathleen Muldoon, PhD
  • How fragmented records and poor tracking degrade patient outcomes

    Michael R. McGuire
  • U.S. health care leadership must prepare for policy-driven change

    Lee Scheinbart, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • A world without vaccines: What history teaches us about public health

      Drew Remignanti, MD, MPH | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • A world without vaccines: What history teaches us about public health

      Drew Remignanti, MD, MPH | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...