Everything related to the delivery of health care in the United States is supposed to be guided by regulations and standards that are designed to assure high-quality outcomes for the patients, right? It’s a noble concept. Every manufacturer of health care devices or products, every health care organization, every provider’s office, and every service organization I have encountered during more than 20 years in this profession claims to be concerned about quality. Specific processes, protocols, procedures and standards of practice are researched, developed, implemented, documented, and validated by every organization that is involved in the business of health care. That certainly would seem to imply that quality should not be taken for granted, and that it would not be sacrificed to achieve higher profits or other favorable business results when it comes to anything as critical as health care. I wish I could say that’s always what we observe as the end result.
For any of you who know me, or who have read more than a couple of my articles over the years, it’s probably pretty obvious that I tend to be vocal on topics that I believe to be important. Hint: This is one of those! I am a very patient and optimistic person in many ways, but I have zero patience when it comes to poor quality service.
The government funded reimbursements for hospitals, specifically Medicare payments, are no longer based on the costs of the care delivery for most hospitals. There are now specific quality indicators that determine whether the hospitals are entitled to 100 percent payment of the defined approved amount for each type of procedure, or if some lower amount will be paid across the board for all of the services to patients who are covered by Medicare. As announced on the U.S. Department of Health and Human Services (HHS) website last January, the expectations for higher-quality outcomes for the patients are being strongly emphasized, and reinforced in the form of financial consequences. By the end of 2016, as much as 80 percent of the traditional Medicare payment amounts may be at risk if the quality scores are below the established national performance thresholds on selected quality measures. That increases to 90 percent by the end of 2018.
How would the HTM profession react if our performance was to be measured through some kind of national ranking system like this, with our individual compensation affected in a similar manner? Would that get our attention? To make it even more pointed, if 90 percent of your annual pay was suddenly going to be based on the perceived quality of the work you perform, would you change anything you do? Take it a level deeper. If 90 percent of your pay depends on the quality of the end result of everything you are involved in, who else would you be more likely to start holding to a higher level of performance? That is what our health care administrators are facing currently. The bar has been raised for them, for the right reasons. It’s all supposed to be in the interest of improving patient outcomes.
For illustration purposes, consider the following situation. Throughout our hospitals and surgery centers, we have a large number of patient monitors from a variety of manufacturers. Some are old, some are new, and that leads to a wide range of potential repair needs. Over about a six-month period, we had 33 different orders for parts or depot service that went to one company. Of those, three different repairs had to go back to them within the warranty period. I expressed concerns, and was granted the opportunity to speak directly with the top “Quality Assurance” person for that organization. Her comments to me? She was sorry I felt that there were issues with their repair quality. Sorry for my feelings, how comforting. NOT!!!
First rule, do not apologize for someone else’s feelings. Each person is responsible for their own feelings. If you really believe an apology is necessary, then apologize for the root cause of the issue! Obviously, that was not happening here. I asked if three failures out of 33 service events was an acceptable level of quality for their organization. The reply was absolutely not, and they would take extra precautions with all future orders from our facilities. Great, what does that mean for any other facilities who may be placing orders or sending devices for service?
Oh, by the way, that count of three quality failures did not take into consideration two other monitors that were returned unrepaired because they didn’t have any boards to swap out. After two weeks of waiting, we requested the monitors back so we could send them elsewhere to actually be repaired. Their count also did not include the critical care monitor that was returned with a different revision of software than it had when it was shipped to them. Fortunately, that was detected by our tech during check-in, and reloaded before it was put in the patient room.
So, what they reported as a 9 percent failure rate was in reality an 18 percent failure rate, with no quality concerns on their end. Oh yes, after they committed to paying extra attention to orders for our facilities, they shipped the incorrect parts on the next order. That took them to a failure rate of >20 percent. I don’t think that would meet any national quality thresholds. Preferred vendor contracts can have great value, or they can lead to blind assumptions that you are always getting a good deal.
This series of service events contributed to a significant drop in our customers’ satisfaction, and resulted in a number of delays in direct patient care. We elected not to use that vendor again, ever. Thankfully, there were no serious safety events directly attributed to these service related issues. What would happen, though, if we put this in the context of quality-based reimbursements?
It’s painful for technicians when they have to apologize to patient care providers, instead of being the heroes, but what if this carried the additional penalty of a proportional pay cut? When you are the face the customer sees, or the voice the customer hears, you represent every part of the service process. You are seen as having some responsibility for the performance of every person who was involved anywhere along that service path. If everyone’s pay was affected proportionally, would that make the concept of quality a little more meaningful for those who do not have to face the nurses or the patients?
This really is a serious business that we are in. The importance of your role, whatever it is in the HTM profession, should never be underestimated. It could be your family member, or yourself, who is depending on that device the next time it gets used. Look around you. What did you just do, or not do, and are you willing to bet 90 percent of your pay on the end result? YOU make a difference in the quality of the care any patient is able to receive. YOU make a difference in the quality of service that is delivered. YOU make a difference in the attitude of everyone you work with. YOU make a difference in the reputation of your team and your organization. Thank you for caring.
Disclaimer Notice: All comments, ideas, opinions or suggestions expressed herein are those of the author and are not in any way representative of the author’s employer or of any organization the author may be associated with.
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