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An important quality measure in hospitals

My hospital has just weathered an impressive upswing in patient volume. The house was full for weeks. The experience highlights an important aspect about quality care–an obvious one that doesn’t always make headlines.

What I notice when the hospital gets full is that patients are sent to units that they don’t normally go to. For instance, at my hospital, like yours probably as well, there are numerous different types of heart units. We have units that see general cardiology problems, some that focus on post-cardiac surgery and one that gets patients after cardiac procedures or heart rhythm issues. An especially nifty thing about my hospital is that leadership finds a way to keep staff together on one unit. Familiar faces treating familiar diseases leads to a specialized team approach to care.

Here is a good example: the unit that most of my patients head to after ablation procedures is also the one that sees arrhythmia patients started on rhythm-control drugs. Without knowing, the staff have all become AF experts. They have heard my philosophy of treating AF and understand well the dangers of over-treating AF. They get the importance of the QT interval. This ‘inside’ knowledge gathered over time allows them to impart specific educational stuff–not generic pamphlet stuff–to their patients. It’s the same on other units: different teams have different areas of expertise. You get the picture.

This degree of specialization is really important. For better or worse, Medicine has grown highly specialized. Though old-fashioned things like compassion, listening and respect traverse all disciplines, familiarity with a group of diseases makes a huge difference. Patient education is key. No, I don’t have a study to quote here, only common sense and years of experience.

My hospital has done a great job retaining skilled and compassionate staff and then keeping them together on teams. These sorts of basics, playground knowledge if you will, which are hard to place on a spreadsheet, are the ones that really matter. (Why do you think acute MI care has improved so dramatically?) Quality healthcare isn’t just about clicks and lists; it’s about people with skills and knowledge, matched with appropriate patients and working in a rewarding environment.

It’s good where I am. I like being part of the teams. Good medicine is clearly a team sport.

Just sayin something positive.


2 replies on “An important quality measure in hospitals”

Thank you for those positive comments Dr. Mandrola. It is not always easy to keep those patients on the “exact” units they should go to, but obviously you as a physician, see the “team” approach as a great benefit to our patients.

Hard to believe all those suits have not found a way yet to quantify the “care” component of “healthcare.” If we don’t keep on eye on the ball, the current movement toward automation, quantitation, and standardization will suck this quality right out of what we do.

In this context, it was refreshing to watch a video recently produced by Cleveland Clinic for their employees. It’s about Empathy. Here’s something absolutely critical to “care” that can’t be reduced to a metric. I hope you and your readers will set aside a few minutes to watch. It is truly a remarkable piece of work.


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