Securing physician commitment to care reliability

For many, many years, critical care was
kind of “fly by the seat of your pants.” You know, there were not a lot of studies proving that
one therapy or one mode of delivery of therapy was better than the other. There is some opportunity to standardize care,
and it really does make a difference in outcomes. I was going to try to engage physicians and
other clinicians on the basis not of money, but appealing to their value system around
what’s the very best thing we can do for patients. If we can demonstrate to them the principles
of variation, reducing variation, shifting reliability, then money suddenly doesn’t matter. Forget about trying to identify the culprit.
Let’s just start identifying best practice. They dropped their guard about whether
they were going to be under scrutiny and started engaging in productive discussion. We have two choices. We can choose
not to address this concern, and do what we think is best
completely irrespective of cost. Then other people will make that
decision for us. It’ll be CEOs, CFOs. If we really want to be able to advocate
for the best care of our patients, then we need to be involved in
that decision, in that debate. I would rather it be physicians
making clinically based judgments than CFOs making judgments based
solely on what the highest target is. If you walk into a room full of physicians,
and you say, “You need to decrease this,” or, “You need to eliminate use of this,” you’ve lost them. Start the conversation about patient care,
start the conversation about quality, and how somehow, how we’re going to —
by decreasing variation or decreasing cost — that that ultimately is going to translate
into improving care for patients. Physicians are going into their job every day and they’re
saying to themselves, “I don’t want to hurt people. So I’m not going to change my practice
because there’s a risk I might hurt people.” But when I hear that this change in practice
benefits patients, and they get better outcomes, and it’s not some study that was done over in
Europe or on the East Coast or wherever, you know, it’s something that was done here. We did
it. We are getting those good outcomes. And this is our patient population. And that’s
something that surgeons really gravitate to.

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