Providers and patients have identified the top 10 health care rules that they say should be changed to improve care quality—and health care executive and managers can take action on the vast majority of them, according to according to a new JAMA viewpoint from the Institute for Healthcare Improvement (IHI).
5 myths physicians believe about patient experience
The Leadership Alliance—a group of 42 North American hospitals, associations, and care systems convened under IHI—urged members in January 2016 to ask patients and staff, "If you could break or change any rule in service of a better care experience for patients or staff, what would it be?"
According to the viewpoint authors—IHI leaders Donald Berwick, Saranya Loehrer, and Christina Gunther-Murphy—the Alliance posed the question as part of its initiative to deliver on the promise of the "triple aim" of health care. The Alliance has established multiple principles aimed at progressing toward that goal, one of which is "Make It Easy"—an effort aimed at identifying and eliminating unnecessary health care rules and regulations. The "Breaking Rules for Better Care" challenge fell under that principle.
According to the authors, 24 Alliance members participated in the challenge. Overall, participants listed 342 rules, regulations, and hospital practices that they said posed little or no value to patients. The top 10 rules that respondents said should be changed are:
According to the viewpoint authors, contrary to expectations that statutory and regulatory barriers would comprise most of the cited rules, the majority of rules mentioned "were fully within the administrative control of health care executives and managers to change."
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Specifically, the authors said that of all the 342 cited rules:
After surveying patients and providers, many organizations took some form of action, the authors wrote, such as clarifying myths and misinterpreted rules, requesting clarifying information from regulatory agencies on the scope and intent of certain regulations, changing local policies that weren't well-founded, and/or lobbying policymakers on any regulations deemed harmful or wasteful.
Ultimately, the authors concluded, "Health care leaders may be well advised to ask their clinicians, staffs, and patients which habits and rules appear to be harming care without commensurate benefits and, with prudence and circumspection, to change them" (Rappleye, Becker's Hospital Review, 6/7; Berwick et. al, JAMA, 6/6).
Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.
Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief."
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