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O R E X C E L L E N C E. C O M S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U N E 2 0 1 4
• An altered environment. A hospital is no longer the community pillar I
knew growing up, with its altruistic mission guiding its decisions. Hospitals have
merged and transformed into giant corporations with little accountability — and
they like it that way. Patients are encouraged to think that the healthcare system
is a well-oiled machine, competent and all-wise. It's not. It's actually more like
the Wild West.
• What goes wrong. Doctors swear to do no harm. But on the job they soon
absorb another unspoken rule: to overlook malpractice in their colleagues.
Doctors are generally well intentioned, self-disciplined, and well trained. Most
medical-school applicants would detest a career goal to overtreat patients or
prescribe expensive interventions. But this is how doctors are socialized. We're
subtly taught a bias toward treatment rather than restraint. And while we don't
like to admit that the almighty dollar can influence our medical decisions, we all
readily concede that it does — for other doctors.
• The importance of culture. Much of the wide variation in the quality of
your medical care can be explained by culture — an institution's level of team-
work and its local sense of common mission. Culture is why a nurse at one hos-
pital will, following orders, administer a medicine even though she believes it
was ordered incorrectly, while at another hospital, a nurse will insistently page
the ordering doctor for clarification.
• What transparency would do. The shocking truth is that some presti-
gious, large hospitals have four to five times the complication rates of other hos-
pitals in the same city. And within good hospitals, pockets of poorly performing
services abound. Transparency of hospital outcomes for common services
would reward good performance, identify bad outliers, and drive improvement,
harnessing the power of the free market as it should. We do harness the power
K I C K E R
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