Now at Beth Israel Deaconess Medical Center, Shah is working on an ambitious project with the hospital's finance office to determine the true costs of labor and delivery, dissecting each piece of that care pathway from patient check-in to discharge, asking who does what job and how long it takes. The goal is to reorganize the process to minimize its cost and improve quality.
Avoiding harm and pain
South of San Francisco, Alan Schroeder, MD, chief of pediatric inpatient services at 327-bed Santa Clara Valley Medical Center in San Jose, and colleagues are working on eliminating care for children that's unnecessary, costly, and sometimes actually causes harm and pain.
Three years ago, they looked at the common pediatric practice of performing routine imaging on children under age 2 with a urinary tract infection and fever. The protocol at most hospitals involved a care pathway that included a painful, often traumatic follow-up catheterization procedure called a voiding cystourethrogram to detect potential problems in the child's kidney.
That procedure costs about $2,000 and exposes infants to unnecessary radiation and prophylactic use of antibiotics, with no benefit to their course of care, Schroeder says.
"As physicians, we're not that connected with cost, so doctors often just shrug it off," Schroeder notes. "But when you start to see that these unnecessary tests are harming the patient by exposing them to radiation, pain, or positive tests that are of questionable significance, leading to further testing and treatment based on an original test that shouldn't have been done in the first place, that's the huge issue that keeps coming up."
At Johns Hopkins, Reuland notes that times are changing, and senior leaders need to think about the process of providing care in much different ways, because the definition of doing the right thing is changing rapidly.
"In the past 10 years, it's my observation that our medical training program has certainly focused more on teaching our physicians and residents that utilization management is important," which wasn't so much the case in generations before.
Now, he says, "it's about a hospital's long-term sustainability. If you're an organization that's not perceived as doing the right thing, that's a sustainability problem in and of itself."
This article appears in the January/February 2014 issue of HealthLeaders magazine.