Satisfaction VS Quality

The following is extracted from data presented by the Dartmouth Atlas.


Data about high ranking academic medical centers is plotted above.  On the vertical axis is the patients rating of their experience at the hospital — the higher the percent the better.  On the horizontal is the rate of a severe infection complication of tubes put in the veins (which should be taken out periodically) — the lower the rate the better.  The hospitals in the lower right have the highest rate of undesirable “line” infections AND the lowest rating by patients.  The hospitals in the upper left have the lowest rate of such infections AND the highest satisfaction.

The point is:  the hospitals are all over the map (poor reliability).  Worse yet, patients seemed to give some hospitals high marks for poor performance.   To be fair, very few patients actually get line infections so the negative effect on overall satisfaction is small.  It would be interesting to evaluate  satisfaction of patients who had line infections (if they survive).

So, you say, hospitals need to work harder.  That would be true but where are the guidelines for removing these problematic vascular catheters?  The CDC and others describe how to care for the catheters but leave it to “judgement” when to take them out.  The problem is “judgement” is not conducive to reliability.

Make a rule and follow the rule!  Sure there are exceptions, like it’s the last vein the patient has — judgement is when you state why you are not following the rule.  The specter of malpractice litigation is here.   Although the rule of law is doctors are not held responsible for a well considered judgement (which later may prove to be wrong) it often does not work that way in court.   So,  a good defense would be that a national guideline was followed — if it existed.

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