Making Health Care Sensible

SARA ENGRAM

May 02, 1993|By SARA ENGRAM

Vice President Al Gore tells a story that is typical of many hospital visits -- and one that helps explain why our health care system is in such a mess.

It seems that one of the Gore daughters almost choked on a feather from a pillow. She recovered, but as a precaution her father took her to a hospital emergency room. Hospital personnel said they wanted to take an X-ray.

Would a feather show up on an X-ray? he asked.

No.

Then why take it?

The answer: It's standard procedure.

"Standard procedures" that are useless but costly are one of many signs of a system that has lost sight of its chief purpose -- making patients better. One of the biggest challenges facing Hillary Rodham Clinton's task force on health care reform is refocusing the system's priorities on the needs of patients, rather than the bureaucratic requirements of providers.

There are a number of ways to do that, but one sensible approach is evident in a cooperative program between the University of Maryland School of Nursing and the University of Baltimore's Robert C. Merrick School of Business to offer a joint program in nursing and business, with degrees offered both at the masters and Ph.D. levels.

The program, now in its second year, is one of 32 such ventures around the country, and it represents the kind of interdisciplinary approach that will be needed to create a health care system that can hold down costs while improving the quality of care.

Doctors get most of the attention, but it's nurses who do the daily coordination and delivery of routine health care. That is especially true in hospitals, where a large proportion of the nation's health care dollars are spent, and where nurses participate in all kinds of decisions that have financial repercussions.

Dr. Mary Etta Mills of the School of Nursing points to a number of ways in which nurses have a direct impact on the quality and cost of health care. They have a great deal to say about what types of supplies are ordered, ranging from expensive monitoring equipment to the computer systems and software used to keep track of patients and their treatments.

Nurses are also central to ensuring good care during hospital stays. Take X-rays, or any other kinds of tests. If you're sick enough to be hospitalized, unnecessary tests can be uncomfortable as well as inconvenient. And, more often than hospitals admit, carelessness or confusion results in inaccurate results -- or results that simply get lost. In either case, the test has to be repeated, regardless of cost or discomfort to the patient.

Nurses who understand the price of such wasteful procedures -- both in terms of patient satisfaction and dollars and cents -- will be more likely to manage schedules and monitor procedures more productively.

"The key here is not just learning finance in isolation," Dr. Mills says, but also "learning how to evaluate outcomes and what makes good care. It's not just adding up numbers, but learning to think critically about patients' needs."

Nurses can hold down costs in other ways as well. Dr. Mills gives a real-life example from a local hospital, where operating room nurses noticed that expensive surgical instruments often got tossed down the chute with dirty laundry. A nurse suggested that the hospital run a metal detector over the laundry before sending it out to be cleaned. As a result, the hospital is recovering about $100,000 worth of instruments a year.

In the three-ring circus of modern hospitals, that kind of common sense doesn't automatically come to the fore unless people are trained to take a broader view of health care resources.

Nursing schools are taking the lead in this multidisciplinary approach. Currently, medical schools give physicians of the future no training in the finances of health care. As a result, many young doctors never encounter the tangled reimbursement system until they try to set up their own practice. At that point, they're usually in for a rude awakening.

Any effective health care reform will bring far-reaching changes. But reforms will be more likely to succeed if they encourage common-sense solutions -- such as efforts to train nurses and doctors in the ability to think critically about the costs and benefits of all the routines and procedures that we take for granted.

Anyone who has spent time in a hospital knows firsthand that common sense -- creating environments that are more attentive to patients than to "standard procedures" -- could go a long way toward making the American health care system more effective at far less cost.

Sara Engram is editorial-page director for The Evening Sun.

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