An Open Letter to Jeff Bezos (Amazon), Warren Buffet (Berkshire Hathaway), and Jamie Dimon (JP Morgan Chase)
by Patricia Morrill
Thank you for your collaborative efforts to work on changes in healthcare. As you brainstorm your approaches to reducing healthcare costs, please pay attention to the poor statistic that preventable medical errors are the third leading cause of death in the United States1. Though significant progress has been made in the quality of healthcare, there has to be greater emphasis on patient safety and reducing preventable harm.
Cost of Harm
The costly impact of preventable harm is not just realized in the most publicized medication errors and hospital infections, but also caused by un-coordinated care. With the high rate of mergers occurring, creating very large healthcare organizations, that will seemingly not help to improve coordinated care.
Reducing preventable harm is necessary so we can save lives and dollars by eliminating added treatment measures to fix the harm (such as additional medications, doctor visits, readmissions, second surgeries), then checking to make sure the harm has been corrected (more doctor visits, repeat lab tests, imaging studies).
Changes in healthcare delivery and cost structures require changes in workforce job descriptions. We need more positions focused on coordination of care – not just on transition of care to other institutions – but also within the walls of the same organization. Once a primary care physician refers a patient to a specialist and/or a procedure, the current complexity of communication channels and insufficient dedicated workers for coordinated care, increases risk. Preventable harm is a system-wide issue, rarely one individual’s fault, and needs to be raised to the strategic level (including the board) as a hot topic. Everywhere we turn, we hear about cancer and heart disease – the top two causes of death. It is time to raise awareness about the third leading cause of death and the need for patient care coordination advocacy.
The great work that patient navigators have done to primarily help guide cancer patients through healthcare systems is a proven model that needs to be expanded to other disciplines. Navigators who are not clinically trained can coordinate referrals and appointments; work with insurance payers to help patients stay within network; and facilitate timely care.
Increasing clinical care coordination roles is important for questioning the appropriateness and need for certain medications, procedures and diagnostic tests; also to facilitate records between institutions that don’t share electronic medical records to avoid duplication of any tests. Assisting with patient understanding of diagnoses and treatment regime at home is important for health status to reduce physician visit costs for non-compliance.
For patients admitted to a hospital, nothing takes the place of a patient advocate who observes care delivery in action; speaks up and asks questions on behalf of the patient; can physically go get a nurse to help when a patient is in distress; and to ensure clarity of discharge information. This is the best way to keep patients safe from harm – not leave them alone, medicated, confused and vulnerable to navigate the complexity of the healthcare system.
Cost of Poor Quality
The cost of poor quality – the cost of not doing it right the first time – is the key metric every healthcare organization should focus on for improvement. As you invest your time and funding in new healthcare strategies, I urge you to take action to increase avenues for coordination of patient care to improve the statistics on preventable harm – doing it right the first time – which will result in lowering cost.
1Makary, Martin A., and Michael Daniel. 2016. “Medical error – the third leading cause
of death in the US.” BMJ, i2139. DOI: 10.1136/bmj.i2139.
I am passionate about spreading information to make preventable harm more discussable so we can reduce the poor statistic that preventable medical errors are the third leading cause of death in the U.S. By integrating Lean and Project Management methodologies, we can implement organizational change more rapidly.