View from Washington – A Healthy Discussion

Have you ever gotten on an airplane, sat next to someone, and they asked you “What do you do for a living?” Having more airline miles than Wilber and Orville Wright, I have gotten this question quite a bit over the years. Trying to explain what exactly you do in healthcare to the lay person can sometimes be difficult. In part it is trying to get all the jargon in healthcare broken down so it can make sense as we explain our individual roles in serving patients. Invariably it seems, the person asking the question tells me some story about a bad healthcare experience for themselves or one of their loved ones.

I have noticed the growing frustration of fellow passengers in their stories. Often tales of high costs and poor quality related to a healthcare experience make their way into the conversation. Testimonials are given about things that are wrong about healthcare today. If you listen long enough to what these people are saying, it becomes clear that a large part of what they are describing is based on the hard fact that healthcare today engenders fear for the patients and for their family/friends.

How many times in healthcare have you ever heard a colleague say, “Healthcare is designed for everyone else but the patients”? Along with concerns about where healthcare is going in this country, you only have to pick up the daily paper or read the published stories on the Internet, to feel the oppressiveness about what is “wrong” about healthcare today. Quickly answering my fellow travel companions with stories of confidence about what is still good about healthcare has become harder and harder. It has been increasingly easier to just listen and nod.

Candid conversations with CEOs
Recently I had the pleasure of listening to a group of hospital Chief Executive Officers (CEOs) and Chief Medical Officers (CMOs) involved in a candid conversation about a real concern they have about the healthcare being delivered in their facilities. I would think I am too old now to be really surprised but how they described the problem before all of them, and what they plan to do about it, renewed my faith in a field I have spent my life working in.

There are currently several different drivers in healthcare today that continually push for ever-increasing efficiency while at the same time, demanding the highest quality of care. Nowhere has this dynamic tension been felt more than in the operating rooms of today’s hospitals. One of the major areas of routine examination by CEOs and others continues to be how quickly the operating rooms are being “turned over” or how fast can the surgical suite be made ready from one patient to the next. Over the past several years, there has been a relentless push for faster and faster operating room turn-overs.

Maintaining quality
During this current wretched economy, many industries are asking more of their employees. The level of productivity of workers today continues to go up year after year. But what happens when it doesn’t go up? What happens for people that are giving 110 percent to their employers every day? Seasoned business executives know the answer. Mistakes begin to increasingly creep into production by over-worked employees who are continually asked to go faster and work harder. Quality eventually does begin to suffer. In this aspect, many argue that healthcare is no different than widget making. And, doctors and nurses that are constantly being pressured to move surgeries through the operating room faster and faster are subject to the same rise in mistakes.

I admire the “time out” procedures that can be called in an operating room today by anyone involved in an operation. When I entered the field many decades ago, no one would ever question a doctor during surgery. Things are different today when even a medical technician can call a “time out” if they discover a mistake in the making. And if an error does occur, all the hospitals and physicians I deal with take the incident as seriously as a heart attack. There also has been a relentless push in recent years for quality improvement, that I am proud to say has given providers the opportunity to improve and, in many cases, to be able to routinely demonstrate it. So, great steps have been made toward rebalancing the dynamic of patient safety, quality, and efficiency. What I wish the general public could know more about is that the best facilities today have rededicated themselves to maintaining a culture of quality.

Being the patient’s advocate
Back to the hospital CEO and CMO conversation about operating room turnover time. In an economic sense, turnover time can sometimes mean the difference between profitability and losing your shirt on a series of procedures. People outside the field might reasonably expect the leadership of these hospitals to be single-mindedly focused on faster and faster turnover times.

But that’s not what I heard recently. I heard hospital CEOs sincerely talk about their concerns that their operating room staff has been pushed so hard and for so long that “mistakes are bound to increase.” I heard CMOs talking about quality as first and foremost in the mission of their institutions and how “we are just going to have to let payers know that medical personnel – human beings – can only go so fast and still maintain consistent high quality.”

As I listened to the discussions, I must admit, it was one of the best moments I have experienced in my entire career. I was proud of these guys. They were saying that the constant push for efficiency was likely to harm their patients and that they had to push back as the advocate for the patient.

Is there more to be done in terms of increasing hospital efficiency through better procedures and enhanced technologies? Sure there is! Can quality be improved? Sure it can! But what these hospital leaders were saying is that diminishing effects are a reality with faster and faster operating room turnovers.

Something has to be done, and the guys to do it are the dedicated men and women in hospitals today, in whose hands the miracle of modern medicine rests.

The next time I get on an airplane, I can’t wait to sit next to someone so I can say, “Ask me what I do for a living!” I can’t wait to tell them a story about what is best about healthcare today. It is complex and the challenges ahead are many, but I believe that the dedicated men and women of healthcare today can rise above these difficulties. Most importantly, what is best about healthcare can be preserved for the patients it is our responsibility to care for. The hope for this achievement rests with those of us in healthcare. As long as we recommit, first and foremost, to act as the advocates for our patients, we can reduce fear and regain the trust of patients it is our privilege to serve.

About the Author

Robert Betz Ph.D.
Robert Betz, Ph.D., is president of Robert Betz Associates, Inc. (RBA), a well-established federal health policy consulting firm located in the Washington, D.C. area. Additionally, Dr. Betz is an adjunct professor teaching at The George Washington University where he specializes in political science and health policy. For more information about RBA, visit