According to Charles Duhigg in his newly released book, The Power of Habit, Rhode Island Hospital was one of the nation’s leading medical institutions. It was the teaching hospital for Brown University and the only Level I trauma center in southeastern New England. Rhode Island Hospital also had a reputation as “a place riven by internal tensions”. In one surgery for instance, a neurosurgeon was preparing an emergency surgery for an elderly gentleman with a critical subdural hematoma. Just before the surgery a surgical nurse noticed that the medical chart and other paper work did not indicate the location of the hematoma. The nurse cautioned that the surgeon should wait until the needed paper work was seen. The surgeon yelled at her that he had seen the cranial scan and said he knew where to operate. He didn’t. He opened the skull on the wrong side. Although he corrected his mistake quickly, the patient died soon thereafter. Such errors are not foreign to most hospitals but the number of errors at this hospital due to poor communication, especially between nurses and physicians who overpowered them with their authority, eventually created a culture of high tension and anxiety.
Posts Tagged process improvement
What are the hallmarks of a well-managed practice? There are many, but here are 10 basics.
- The practice has foundation documents appropriate to the corporate structure and written agreements describing how income and expenses are shared by physicians and/or other providers and how partners enter and exit the practice. The owners of the practice and management meet monthly.
- The practice has documents that set the guidelines for operations such as a compliance plan, disaster plan, personnel handbook, job descriptions and requirements for annual evaluations, raises, bonuses and progressive discipline. Management and staff meet monthly.
- The net collection percentage is 95% or more. This means that of the expected collectible dollars, 95% is collected.
- The practice has a budget and variances are addressed.
- The unfilled appointment percentage is 5% or less. This is in retrospect, so it includes no-shows. The practice has a marketing budget and a written marketing plan.
- The practice has a line of credit or other means to draw upon in the case of unexpected cash flow drop.
- A single commercial payer comprises no more than 50% of the practice business.
- Employee turnover rate is 10% or less. New employees are onboarded with training, coaching and competency testing.
- The practice has the ability to produce management reports to track and trend production, payments, adjustments, and denials. Process Improvement (PI) is used to address negative trends.
- Patient satisfaction is prioritized and measured, and improvement is valued.
What other hallmarks would you add?