Standardize your processes! You can save time, money and prevent errors. Things
you do over and over should be done the same way every time, if indeed you do the
task the best way. They say variety is the spice of life, but for healthcare processes
it certainly isn’t most of the time. Consider this, if you would. Would you buy your
favorite brand of soda if sometimes your 12 ounce can were 3/4 of the way full and
sometimes almost overflowing. Certainly not. You expect there to consistently be
nearly 12 ounces every time. How would a patient behave if the results of a
healthcare visit varied wildly? The patient would probably find a new provider. The
best healthcare providers deliver a consistently good service; it helps attract new
patients and keeps the old ones coming back.

Standardization helps save time. As things become routine, a process is easier to
do and is done more quickly. For instance, if a primary care physician makes sure
that the necessary items for a patient visit are always in the examining room, the
doctor won’t have to waste time going to look for supplies and waste time for the
patient or the doctor. I recommend that primary care physicians along with staff sit
down and list the things that should always be in examination rooms and make sure
someone is responsible for these items every morning before patients arrive. If this
is done, the doctor can save time, thereby enabling him or her to spend more
quality time with the patient or see more patients.

Standardization saves money. Most doctors face rising malpractice costs, but for
one group this has not been trueanesthesiologists. According to an article in the
June 21, 2005 edition of the Wall Street Journal, this group over two decades ago
began implementing procedures that ensured the safety of their patients. Certain
processes have been standardized across the profession so instead of one death per
5000 cases, there is now only one per 200000 to 300000 cases. Because of this,
their malpractice insurance premiums plummeted.

Standardization prevents errors, as in the above illustration. Another example is
drawn form a local hospital. Recently the Chief Financial Officer of the institution
and I were discussing the new facility they were building. Instead of building
adjacent rooms so that the bathrooms would be back to back to save plumbing
costs, each room was designed so that each room will be exactly the same with
bathrooms all on the same side. Why? This will prevent errors and in the long run
save money for the hospital.

It is best if you can measure standardization. The best tool to measure
standardization in statistics is variance or standard deviation. I am sure many of
you have encountered this measure, but probably cannot calculate it. The best way
to calculate it is either in a spreadsheet or on a calculator. For example, the
standard deviation for the numbers 8, 12, 1, 4 and 5 is 4.18. For the group 5, 5, 5,
5, and 5 the standard deviation is 0, since there is no variety. So, when you are
trying to standardize a process, see if you cannot find some significant measure
that reflects the process and try to reduce the standard deviation as much as
possible. In fact, this is the heart of Six Sigmareduce the standard deviation as
much as possible. The best manufacturers and service providers often use this tool.

Once you have standardized a process and have achieved a satisfactory standard
deviation, then write down the process in a manual that is a collection of all best
practices. This way, anyone who needs to reference how a process should be
conducted can refer to the manual. Too, it is an excellent training source for new
employees.

As you can see in these brief illustrations, standardization or the lack of variance
provides safety for patients, a savings of time for the provider and patient, and
contributes to an improved bottom line.

Mr. Bryant helps healthcare providers meet their challenges. He helps save
time, improve patient health, and improve the bottom line. He publishes a
monthly newsletter “Making Good Healthcare Better.” All of this is done from
the perspective of a certified quality engineer and statistician.

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Dental practice in Ireland is of the highest standards in the world. That is also true of our medical practice. Our teachers at our hospitals are, in many ways, quite extraordinary. They have strong academic backgrounds and training, and are committed genuine and passionate people. These people are given the job of training undergraduate and graduate students to the highest possible standards of knowledge and practice and that is what they give their all to accomplish. When students qualify they are committed first class graduates for the most part. This is all great news. So where is the problem?

The ideal versus the ‘real’ world

Many medical and dental graduates will tell you about the culture shock that they experience when they come out into what is called the “real” world. We have been trained to provide the Gold Standard in treatment but suddenly we are expected to do our work ‘under pressure’. The cruel task-master going by the name ‘economics’ but better known simply as ‘money’ comes in to take control all of our activities and this is where our problems really begin. The exacting and exhaustive precision with which we were trained to provide excellence of service comes into clear and sharp conflict with the constraints of ‘money’ and the other well known lord of economics ‘time’. These omnipotent dictators are of course related to each other. How often is the dictum proclaimed, sometimes with a sigh, sometimes triumphantly, sometimes almost reverently, but always with faith and conviction. “Time Is Money” we are assured.

Is this the same job I learned in the hospital?

To give you all some idea of the size of this culture shock that I refer to, consider this. A job which would take up to two hours as a student under supervision is now afforded maybe 15 - 20 minutes. This is a speed up factor of 4-6 times the taught rate in the Teaching Clinic. This jump in speed is expected to be accomplished immediately and is experienced as real pressure by the new graduate. Yet in this ‘real’ world it is Time and Money which must have pride of place.

We must now speed up so that we can be “acceptable” in the market place in terms of how long the job takes and how much the job costs. We are still expected to produce the Gold Standard which we were trained to provide in the hospital situation, yet the conditions in which these standards were obtained are now drastically different. The pressure has begun.

Government and politicians will safeguard the sanctity of the healing arts?

As if all that was not bad enough, we now allow/decide that authority in healthcare is the business of politicians and government. They become the paymasters and who pays the piper calls the tune. Suddenly, what we do and how we do it is being evaluated by people who know nothing of the burden of duty and responsibility that comes with the allegiance to Hippocrates.

Next comes our dealing with Government Departments. Remember that I am not talking about the people in these departments. They are merely trying to do the job that they were asked to do. I am talking about the systems. So the Department is going to provide Treatment for workers but it has limited resources. So it “negotiates” a deal to have work done by dentists/doctors at reduced cost. This is not a real negotiation because dentists are made to feel that unless they give in, they will lose their livelihood. So they ‘agree’ to reduced fees. Now the pressure intensifies because the required standard remains the same but the ‘time allowed’ to achieve it is reduced.

All decisions have consequences?

Needless to say the increasing strain puts pressure on all the components of the system. The practitioner is under pressure in many ways. The cost of being in practice, wages, insurances, rents, rates, materials, laboratory are high to begin with. These increase year on year but the pressure is always intense to keep fees down. The first pressure is self-induced. This stems from the perception that people will not come to the practice if the prices are too high and so fear of the loss of business rules. State funded schemes are always at very reduced fees and so are a burden to the practice anyway. The solution to the problem is to either increase fees (and the fear of loss that comes with this is very strong) or do more work. Doing more work will involve either longer hours or working faster to get more done. Maybe it will involve a bit of both.

Look in honesty and without defensiveness.
There are many consequences to the decision which many have to work longer and/or faster. The study of these consequences reveals the very origins of the hazards that have come to be associated with modern general practice. While I can appreciate that it may be difficult to look upon these truths, surely it must be good news to find the origin of the problem. For only in identifying the cause of a problem can a solution becomes possible. The alternative is to continue with the same methods which are bringing as much pain and suffering to the practitioners as they are to the people that they purport to serve. How ironic and indeed unbelievable that we have not noticed that our ‘healthcare’ system as it is currently constructed is causing the sickness and pain that it was set up to eliminate?

Is this really what we want?

As we look honestly at our methods and the results they bring, how can we say that we are satisfied that we are going in the right direction. As we analyse the consequences of how we operate our systems and see how one things leads to another, it must become obvious that the most radical change is needed. When will we bring some light to the hell that we have created and continue mindlessly and blindly to support? We like to think of ourselves as scientists but since what we do and continue to do is totally illogical we cannot apply the term meaningfully.

Science must be logical to be itself and a lack of logic is a lack of science. To continue to use something which brings the opposite of what it was designed for, speaks volumes about the blindness that operates in healthcare. What hope could there be in asking blindness for direction? What can we deliver from blindness but chaos and confusion.

My name is Philip Christie. I qualified as a Dental Surgeon at Trinity College, Dublin (Ireland) in 1980 and completed a Master’s Programme in Dental Science, again at Trinity College Dublin, by research in 1995. I have been working full time in dental care either in general practice or specialist practice since qualification. My main interest is and always has been prevention.

My real qualification is 23 years experience in dealing with real people and their problems face to face, as a clinical practitioner.

I am the author of “Something To Chew On: A Mouth Map To Health”. It is a Health Manual with a difference. Different because it is designed for the future and for success. It is different because it gives the power back where it belongs, to the person’s own self. Different because it prevents problems at source and saves on treatment and cost!

Philip.christie3@ntlworld.ie
http://www.peopleaspartnersinmedicine.com

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