Beth Israel Hospital (BI) in Boston, Massachusetts, is a hospital with a three-faceted identity. First of all it is a hospital for patients from Boston and the surroundings. The second role is as a research institution and the last role is as a trainings institution where Harvard Medical School faculty members can be trained.
Despite the hospital is one of the best, some people called the organization “an unruly mob”. Malcom Weinier, vice president of clinical and support services, told that the BI hospital has a structure that’s typical for a hospital. “It is part hierarchy, part team, and part matrix, but more team than anything else.” It works like a strong triangle, a nurse, an administrator and a physician manages the service. The hierarchy is for getting things done, the team is for communication.
In the medical world, the quality thinking is penetrated. This leads to different types of questions and issues like: how can we measure quality, how to handle the enormous pressure of time, how can we pay and which hospital is the best for certain complaints.
The Joint Commission for the Accreditation of Health Care Organizations (JCAHO) shifted its attention from auditing safety regulations to insisting that hospitals review all the cases for quality and act on the results. Hospitals are struggling with the question how can we measure quality. In the next paragraphs we will tell more about it.
What happened in the BI hospital characterizes the industry. The increasing attention on quality and the reducing of costs ensures pressure on nurses and physicians to rapidly move the patient through the system. It has a negative impact on the quality and the patient is being treated as an number instead of a human being. Another issue, maybe correlated with time pressure, is the responsibility of physicians for the patient. A lot of patients are stuck in a web of specialists and are driven from pillar tot post.
In the past decennia the federal government was the largest single customer. Now, people have to pay it by themselves or through insurance. Pennsylvania and Colorado are now lobbying for a kind of marketplace where patients are able to choose a hospital based on price and performance. In sum, quality is increasing important but to measure quality in a right manner, there’s a lot of research needed.
Mission and priorities
Delivering patient care of the highest quality in both scientific and human terms, concentrating on a patient-centered environment that encouraged learning and collaboration is very important for the BI hospital. Thus, providing excellent patient care is the mission of the hospital. Patients can’t be numbers but should be human being an must be treated as human beings. There’s a problem by measuring this mission because excellence is an elusive concept. How can we measure quality? That’s the question we have to answer before measuring the mission. Ideally, the right patients would receive the right treatment, at the right time and in the right way, for the right price. Here the problems comes from a different point of view. Each ‘right’ is the responsibility of another physician. For example, the cost and prices are the responsibility of the fiscal group and the treatment is the responsibility of the nurses. Measuring quality is one issue, but how to compare the quality with previous years or with other hospitals is the second issue. There’s a lack of similar measurements and a lack of data that can be compared. Eugene Wallace, chief financial officer, would like to develop a database that match with this kind of problems. Priorities like quality, the measurement of excellence, treatment of the patient, training and research and so on, are important issues for the BI hospital and can be regarded as their priorities.
Quality and Challenges
According to the CFO of Beth Israel quality is a concept that can’t be...