On the other hand, I understand that there are many situations when the reasons for and results of standardization are not so obvious. There is much ambiguity in medical practice that stems from the fact that it is centered around human to human interactions. There are so many uncontrollable factors in the interactions between doctors and patients that standardization is nearly impossible in many areas, and this is compounded by the fact that many physicians are resistant to taking up standardized procedures even when they are implemented or recommended.
This reminds me of an article that I read in the New York Times several months ago called "If Health Care Is Going to Change, Dr. Brent James's Ideas Will Change It" (<http://www.nytimes.com/2009/11/08/magazine/08Healthcare-t.html?pagewanted=all>). In this article, hard evidence was put forth for the benefits of standardization of medical practice in the Intermountain Healthcare network of hospitals and clinics in Utah and Idaho. The key to the success of standardization in Intermountain was that the standardized procedures were developed by the doctors for themselves. Thus, they were not as resistant to implement the procedures. Also, even when doctors were resistant to implement standardized procedures, Dr. James would show them hard evidence proving that the standardized procedures were in fact, more effective, and most doctors accepted the procedures once they were faced with the hard facts. To me, it seems that this is the way standardization should occur.
Record keeping is definitely an instance where standardization is incredibly useful. Even though the US doesn’t have widespread use of electronic medical records, many hospitals use them. At New York Presbyterian Hospital (both Cornell and Columbia) they have patient data inputted electronically. Even when I go to a doctor’s office outside the hospital who is affiliated with the hospital, they can pull up that electronic record. It is really useful because if they ask me about a test result from high school, they can just pull up the file and see the actual numbers from the test. Also, they have a patient portal so from your phone or laptop you can view your upcoming appointments, past appointments, and your medical history. When I see a new doctor at Cornell, I don’t have to fill out my entire medical history again. I just correct for any changes and fill out an additional section depending on the specialty. This is so much easier than having to fill out almost exactly the same 3 pages of information every single time you see a new doctor.
ReplyDeleteI agree that this thoughtful read was not always intellectually stimulating because of its seemingly obvious points, but I appreciated that it connected well with the demand for high quality healthcare in this country we learned about in previous readings. Bottom line is that as standardization continues to expand with the growth of evidence- based medicine, we continue to adopt and accept it into many aspects of our lives. That said, we have trouble reaching the healthcare expectations we hold onto because of that constant fear that standardization will threaten medical creativity and doctor judgement. I think that as the younger generation who has grown up with technological dependencies ages, the population that questions standardization because of its stunted human interaction will become far and few between and standardization will become more regular in medical care. The most important thing that hospitals need to consider is the quality and safety of its patents. Standardization reduces the treatment variation in patients, thus reducing the potential for errors which makes the patient feel safer and better taken care of. Forgetting patients for a moment, being able to predict treatment allows for doctors and nurses to have more control over the situation, which in a profession that is often times chaotic seems like a favorable bonus. Our lives are more complicated and moving at a faster pace than then our older family members remember growing up, so it seems obvious that we live in a culture that adapts to our changes in lifestyle; This includes a hospital and staff as high- tech dependent as the people they are helping.
ReplyDeleteThe process of standardization seems like an easy way to alleviate the medical industry from making medical errors, but its hard to eliminate all errors even with a flawless system. I doubt that errors in the made in the medical field greatly outweigh any other errors that are made in other fields. However, medical errors receive a lot more attention than errors in other fields, and rightfully so. When human lives are on line, all steps should be taken to develop a system that could prevent as many errors as possible. I talked to my father who is a doctor about this and he said a system that they are implementing is the "check system." The way this works is that before a procedure is to start, the doctors must create a checklist that they have to fill out during the procedure to make sure they did not forget anything and remember all their responsibilities. With this and many other systems of safety protocol, I believe that we can help minimize medical errors.
ReplyDeleteI agree with Cece point. To touch on Dana's point, although there are hospitals that use electronic record-keeping systems, many of those systems have just been recently implemented. For example, I volunteer at Columbia presbyterian and they have been, only very recently, transitioning from paper to electronic record keeping. I know this because it took me a week to learn how to use those portals (for signing in and out) and it took the entire volunteer department months to get everyone assimilated. Only until I read The Gold Standard, did I wonder why are they only doing this now. Mind you, New York Presbyterian is ranked #6 on the US news and World report best hospital list and if one of the best hospitals in the country is just beginning to transition from paper to electronic, I wonder how many other hospitals are also transitioning. Because of my blundering experience with the portals, I wonder if the reason that hospitals are reluctant to change is because of the hassle that is usually involved with changing the norm. However, after the initial month of confusion, the portals proved to be a more efficient system. Therefore, if standardization is to occur, the fear of change and confusion must be overcome. At first, it might be flustering to change very large aspects of hospitals' routines but if it will reduce error and increase efficiency, they need to suck it up.
ReplyDeleteI agree with Kelsey's point on how the younger generation is more intertwined with technology and what it has to offer. Even though the expansion in standardization has its drawbacks, the young generation has the knowledge and equipment to handle such changes. We know that electronic record keeping is much more convenient but the training is time consuming. Just like Sammy said, training all the people will take a long time, but I'm sure that there are systems in which they made this process shorter and more efficient.
ReplyDeleteThat being said, the chance of error is eliminated in very significant way. I as a patient trust electronic record keeping systems more than human record keeping, and I believe that everyone agrees. Therefore, medical institutions have to accept the fact that it is more work and time consuming but has better outcomes once people adapt to the change.