Complications after Surgery — blame or improve?

carrot-stickThe long and difficult training for surgeons often leaves them with little intrinsic drive to improve surgical care.  Anyone who has had to discuss surgical quality with practicing surgeons is lucky to leave the discussion without a fear of losing their job.  So, with little intrinsic drive to improve quality, the government and insurance companies resort to the old carrot and stick methods.

For surgeons the carrot and stick are financial.   So, if a surgeon and associated hospital have patients that are readmitted within 30 days the hospital is penalized — the hospital is unhappy and verbally passes that unhappiness on to the surgeon.

A study just published “Underlying Reasons Associated With Hospital Readmission Following Surgery in the United States” expresses surgeons’ negative opinions of the penalty saying it really won’t have much effect on surgeons — wow, what a stonewall attitude!

The argument is based on the findings that surgical patients return to the hospital because of an infection where the skin was cut or because of bowel problems from pain medication.  Somehow, the surgeons writing the article seem to think complications, coming to light after the patient leaves the hospital, are beyond their control — so the hospital should not be penalized.  In other words, complications are and ACT OF GOD.

Wrong answer!  Patients, families, insurance companies and Medicare do not want to further enrich surgeons and hospitals for bad outcomes.  A much better answer would be to double the efforts to improve quality and reduce complications and to have surgeons spend more time out of the operating room figuring how to improve surgery in the operating room.

Admiral David Farragut is attributed with the phrase “damn the torpedoes, full speed ahead” — was he really a surgeon in disguise?  We all know intrinsic motivation (dedication and innovation)  is much more effective than extrinsic motivation (carrot and stick).   Intrinsic motivation comes from training programs that place emphasis on quality and downplay personal profit.

The solution:  surgeons should be employees of the hospital (an ACO model) so they personally feel the financial pressure to minimize costly complications — not just watch as the hospital is penalized.  And, improve post-graduate surgical training to have more emphasis on quality.

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