Atul Gawande's 80% Healthcare Solution

Joe Cantlupe, for HealthLeaders Media , September 20, 2012

It was a surprise to us that Max landed in the hospital Friday after battling a sore throat for days. On Thursday, his physician recommended an ear, nose and throat specialist do a procedure. After seemingly successful outpatient surgery, my son, who was battling dehydration, was immediately shaken with violent chills, and later, intense sweats.

The doctor matter-of-factly said we could drive him to the emergency department for IV rehydration, if we wanted, or we could go home and see how he did. We thought our son looked awful, so we opted for the hospital, which the ENT contacted to inform of our arrival.

I dropped off my wife and son and went back to work. When I showed up again an hour later at the hospital, my wife hurriedly told me my son's temperature had spiked to 104.8%, his heartbeat raced to the high 170s. He was whisked back to a bed, where doctors and nurses surrounded him to work on him "stat!"

The situation could have been serious. Their care stabilized him within an hour, as his fever and heart rate lowered with treatment. Our son stayed at the hospital two nights before he was allowed to go home. And when she called our house to check on him, my son's primary care physician told us it could have been a life-and-death matter.

I was seeing healthcare up close and personal and it wasn't pretty.

Why didn't the ENT suspect anything when our son was shaking with chills in his office after this dreadful procedure to remove the abscess? What would have happened if we had driven him home instead of going straight to the ED?

During the hospital stay, other things popped up: some nurses were incredibly nice and helpful; others were brusque. The staff told Max they wouldn't wake him up until the early morning, but instead put on lights at 3, 4 and 5 a.m. to check on him. 

Before he was discharged, nurses advised seeing another doctor because his blood work indicated double the level of liver enzymes compared to normal. "Are you sure?" I asked the nurse.  She called the physician on duty. "Oh, it's OK," she said later, apparently coming up with a cause for the elevated numbers after conferring with him.

It was an episode of healthcare showing initiation, teamwork, and purpose, but with some small, and not-so-small miscues along the way. Despite Max's big, one-bed room, and the dimly lighted hallways, and the flat screen TV and Wi-Fi access, some things were out of kilter. Not a lot, but enough to spike our concern.

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2 comments on "Atul Gawande's 80% Healthcare Solution"

sdaniels (9/21/2012 at 9:01 AM)
Only when the hospital can rid itself of its archaic dual governance structure and adopt a top down quality culture, can it truly hope to emulate the quality and consistently of the Cheesecake Factory. With Boards and execs who are loathe to confront the "accommodating culture" that pervades most of the healthcare industry, there is little hope of successfully confronting the fragmentation and problems so artfully described in Brownlee's "Overtreated" and Markary's recent "Unaccountable."

Adrian Byrne (9/21/2012 at 8:43 AM)
Joe has correctly noted, Atul's commentary on the Cheescake Factory solution is 80% correct. In the words of my friend Dr. Ed Henegar we must plan for the normal and manage the exceptions. No amount of systems or standardization will cure all. Anyone in hospitals who has worked with Sodexho or other outsourcing companies will know the product and service is only as good as the on site manager. Meanwhile, there is still a lot Healthcare can learn from other industries.




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