I have mentioned Dr. Kent Bottles, before, in articles. He really is a very bright guy, as well as an inspiring speaker. A couple of months ago, Dr. Bottles published and article called, “Why Do Academic Medical Centers Do Poorly on Quality Report Cards?” The article is much more than an academic discussion. It is critical for patients and their families to make good decisions about their own health care.
Dr. Bottles’ article was stimulated by a report from the Joint Commission, which is one of the leading accreditation agencies in health care, covering hospitals, home health agencies and so forth. The report of the Joint Commission listed about 18% of the nation’s hospitals as top performers, but missing from that list were a number of leading academic institutions. As Dr. Bottles puts it, in his article,
many were surprised when some of the biggest names in academic medical centers failed to make the cut. Johns Hopkins, Massachusetts General Hospital, and the Cleveland Clinic (perennial winners in the US News & World Report best hospital competition) did not qualify when the Joint Commission based their ranking not on reputation but on specific actions that “add up to millions of opportunities ‘to provide the right care to the patients at American hospitals.’”
The basic issue is not a new one. It is all about optimization. In a prior life, managing major projects in the field of high technology, one of the truisms was that you can only optimize for one variable. You can optimize for cost or you can optimize for time of delivery or you can optimize for features, or you can … What you cannot do is optimize for multiple variables.
Dr. Bottles nails this issue, relative to health care at academic hospitals:
Having been a professor at several medical schools (UCSF, University of Iowa, Allegheny University of the Health Sciences, and Michigan State), I learned early on that the key to academic advancement was NIH funded basic science research. While lip service was paid to the ideal triple threat professor (great clinician, superb teacher, and peer reviewed published investigator), the results of the tenure process clearly resulted in a culture where funded research counted far more than teaching and clinical care delivery.
I have a strong sense that Dr. Bottles may have closely approximated that “triple threat professor,” but there will have been very, very few who could. Again, you can only optimize along one vector.
The hospitals that made the top performers list clearly optimized for quality of care. The lesson to us, as consumers (of health care or any other service or product), is that we should make sure what our potential providers are optimizing, and that should be meeting our needs. At Support For Home Health Care, we work very hard to keep that our focus for optimization.
Best wishes. Bert