Next I do Surgery

So I have been studying for my Certified Healthcare Executive accreditation for the past few months (hence the low number of posts) and it has gotten me thinking about what it means to be a competent healthcare administrator again. This has come up as I have seen a number of reports on recommended quality practices. For instance, an article in the NEJM sponsored by the National Heart, Lung, and Blood Institute, recommended a series of practices to reduce door to balloon time for myocardial infarction patients. What struck me about the list was a number of the recommendations weren't just for clinical folks. Plain old healthcare administrators, in the right role, could implement some of these practices and presumably impact a healthcare outcome.

This isn't really earth shattering on its surface. As healthcare administrators, we talk about improving quality all the time, but most of that talk is around structural or process issues that speak to the cost, availability, or effectiveness of services. We certainly care about patient outcomes, but those measures have been "owned" traditionally by the medical and nursing staff. They were the ones with the training and tools (I would argue that their perspective plays a key role as well) to evaluate the outcomes of clinical care. That certainly hasn't changed and healthcare administrators will always depend on our clinical counter-parts for this.

I think what has changed is the expansion of what is being considered to impact patient outcomes. More and more we are looking at process measures, not just for efficiency sake, but for their impact on the patient. An example is wait times in the ED. We are also looking at aspects of the hospital environment that impact not only patient satisfaction, but health outcomes as well. An example is natural lighting in the patient room.

I have always said that every decision impacts the patient in a hospital, but it is becoming more clear, to me at least, that healthcare administrators impact patient outcomes. What does that mean for us as professionals? Can bad management kill patients? Perhaps. All the more reason I need to pass my test.