Hawaii - Pacific Chapter of ACHE Mobile - Spring 2016 Edition

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Educating Clinicians About the Business of Healthcare

Stefan Fedusiv, MSN, RN

According to the American Association of Colleges of Nursing, nursing is the nation’s largest healthcare profession and Registered Nurses make up one of the largest segments of the US workforce as a whole. The Bureau of Labor and Statistics’ December, 2015 Employment Projections: 2014-2024 Summary states, “The healthcare and social assistance major sector is expected to become the largest employing major sector during the projections decade...” In other words, there are lots of clinicians and their numbers are expected to grow.  While some of these statistics might come as a surprise, the fact healthcare costs in the US are the highest in the world and continue to rise at an unsustainable rate is generally accepted by those knowledgeable in the field.  There is a way we can help bend this cost curve and all it requires is for us to appreciate the differences in how our clinicians are trained to see “the big picture” and to educate them on the “business” of healthcare.

When I was in nursing school, one of the most important and dominant principles emphasized was “to do whatever is best for the patient.” Rightly so. Nursing, respiratory therapy, physical therapy, and other clinical disciplines are generally qualitative even though they all have quantitative aspects. We are compassionate. We listen.  We care.  We know this has value even if we are unable to count or measure these behaviors.  Most everyone knows medical equipment and supplies are expensive, but many if not most caregivers continue practicing with little regard for resource management. This is most likely due to a lack of understanding regarding costs associated with patient care. Managers, on the other hand, have more quantitative responsibilities including finding and implementing ways of improving efficiency and reducing waste. When these two trains of thought collide, everyone ends up with a headache.

There is a difference between quality of care and convenience. For example, in an eye surgery center, it was common practice to have eye drop medications at each patient’s bedside.  This made it convenient for the nurses to administer drops. However, once opened, each medication bottle must be discarded after 28 days. This convenience resulted in many bottles being discarded despite being more than 75% full. At almost $100/bottle, this was an unnecessary expense which had nothing to do with quality of care. Instead, it was a matter of convenience. Once the nursing staff was educated on this situation and understood the reasoning behind the manager’s request, a positive change in behavior was realized quickly and easily. Another example is when various supplies are unpackaged and set-up in preparation for a procedure. While this is a fine example of time management, it results in unnecessary waste and expense when opened but unused supplies must be discarded.  Quality of care is unaffected by these cost-saving changes in behavior. Identifying these cost-saving opportunities requires analysis, critical thinking, and an understanding of the work being performed by the clinicians under the manager’s purview. Once an opportunity is identified, an appropriate modification must be designed, communicated, and implemented. Probably the most important of these is proper communication. The first step is to understand the context of how clinicians approach their work. They generally do not think in terms of patient satisfaction scores, reimbursements, or budgets. And for the most part, they should not. Their focus should be on providing the best care possible. With that in mind, the manager can prepare a presentation in proper context so clinicians will understand the situation and reasoning behind the proposed change. Sometimes, this is enough. Other times, requests will be met with resistance oftentimes because it requires a change from the way “it’s always been done.” Sometimes clinicians think the proposed change cannot be done even though the new idea has never been tried before. Do not be deterred. Be willing to try new ideas and admit it when they are not working. This will teach your staff to become less fearful of change because they know only the successful ideas will be kept.

Despite myriad attempts at cost reduction, opportunities remain which do not require huge training programs, new software, or large up-front capital expenditures. Managers generally think quantitatively and need to be able to measure inputs and outputs. Clinicians generally think qualitatively and spend much of their time and effort on activities which are valuable yet immeasurable. By understanding and appreciating the differences in how managers and clinicians think, simple behavioral changes with large cost-saving impacts can be implemented when properly communicated. With proper education, clinicians can continue to do whatever is best for the patient while being effective stewards of healthcare resources – and that’s good business. If you have any comments or would like to share examples of simple cost-saving discoveries made within your own department or organization, please send them to stefanf@hawaii.edu.

Image courtesy of: http://www.kevinmd.com/blog/2013/03/physicians-role-cost-containment-absent-training.html 

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