How to fix healthcare

I used to be a healthcare architect. after the great recession, i got downgraded to working on ADA compliance retrofits, low tier stuff. in and out of many departments on a weekly basis. nasty working conditions, never been sick more often in my entire life. Our firm received training on HAI. Hosptial Acquired Infection.
 
Did you know HAI kills 99,000+ people per year?
https://en.wikipedia.org/wiki/Hospital-acquired_infection
 
Think about the ratio.  we have over 100 milllion autos on the roads and people drive very day, or at least every week, and there are 36k auto fatalities similar for firearms, 100 million plus in civilian hands. we are a nation of 12k homicides.
 
How many folks check into a hospital per year? 7.6% of the US population, or less than 30 million people. 
https://www.cdc.gov/nchs/fastats/hospital.htm
 
SO HAI is my #1 fix for Health Care.
 
Next i saw the difference in business model between Kaiser Permanente and Sutter Healtlh.
Kaiser membership has an incentive to keep the person healthy, and they have all sorts of programs to education and promote healthy life choices. Sutter just rakes in insurance money and has a vested interest on making as much per patient as possible.
 
This business model difference was highly noticable anywhere i went among over a dozen facilities. at Kaiser the elevator has posting of all sorts of exercise classes, de-stress training, healthy food prep....
so that sort of business model, where the company takes in membership fees form partiscipants and then has an incentive to spend as little of the fees by improving folks overall health seems right (but note this can be corrupted too by denial of care, or other)
 
So thats my #2 to do item for US Healthcare
 
#3 is the pharmaceutical industry. I work for Abbot Labs ealier as an architect and saw how that works, the sales force taking doctors golfing and offering "training trips" to resort locations. its a type of lobbying.
 
The drugs are often rife with unintended consequences. so folks end up on other drugs to counter act these consequences. The entire way that part of the typical "treatment" program works needs to be thrown out.
 
For HAI the biggest failure is human error and poor choices with capital.  Nurses and Docs to arrogant to do the right thing. Adminstration to profit driven to do the right thing.
but that would become a rant.
 
wearing surgical gown, hat and booties outside the surgical unit, out on the sidewalk for a smoke break, to go back inside the surgical suite wearing the same shit it a huge example of arrogant staff causing cross contamination.  the Declined $700k extra on a $140 million hospital expansion (0.5%) to upgrade  both the expansion and the adjacent existing hospital to "anti microbial copper touch surfaces" (door knobs, faucets etc) . the anti microbial copper can look like stainless steel or pewter with a nickel mix, but has the attribute of killing 99.99% of microbes on surfaces very quickly.
 
So i could do this, but whose ever going to ask me, I'm nobody.

 

Comments

John Minehan Added Mar 6, 2018 - 9:15pm
Hospitals and other healthcare entities spend a lot of time and effort collecting data on Nosocomial Infection as part of their CQI/TQM efforts.
 
They gather data on the "M&Ms" ("orbidity & Mortality") within the House almost obsessively. 
 
You raise good points.  Another part of the context is that people in hospitals are sicker than they were and antibiotics have been overused and are getting less effective.   
John Minehan Added Mar 6, 2018 - 9:19pm
This might be of interest . . . .
Phil Greenough Added Mar 7, 2018 - 4:14pm
"SO HAI is my #1 fix for Health Care."
 
Hospital Acquired Infection is not a fix.  A fix is a suggestion that would reduce HAIs and for that I read nothing. 
Doug Plumb Added Mar 7, 2018 - 6:12pm
Cancer Act. Look it up. If you were not a conspiracy theorist before..
Douglas Clark Added Mar 7, 2018 - 6:34pm
Phil Thank you for your comment.
Please understand; the above "article" was really just a comment I posted following another news article on another website and was solicited by the owner of this site to re-post here.
The content was never intended for high level professional review.
However I am glad to address  incorrect assertions in your comment.
In my comment/article above  I do make mention of the following glaring deficiencies in American HAI prevention.
1. Human error/ arrogance of staff to reject/disregard training we know they are receiving to prevent HAI. (no penalties/or liability to staff in our current system when staff disregard to policies and procedure currently in place.) But dont take my word for it, Maybe you would like to hear What John Hopkins University has to say about the overall topic of mistakes by staff
https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us
 key excerpt from the link
"

Release Date: May 3, 2016


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2. Clinical area/surgical area protective garments worn out in public. (other countries do not allow this, Japan for example. I read there are health care facilities in Indiana going back to onsite laundry of all staff uniforms) The back and forth contamination risk has been document in other places, but as a "comment" to another article is seems in appropriate to cite all my source material
take your pick of numerous articles on the topic
https://duckduckgo.com/?q=cliical+uniform+contamination+causes+outside+the+healthcare+facility&t=ffsb&ia=web
 
3. Mis-allocation of capital in major capital development projects . Real Example : to decline less than 0.5% additional costs, (or re-directed costs ) to employ proven technologies used in other countries such as anti microbial copper touch surfaces (human error form capital development decision makers)
https://en.wikipedia.org/wiki/Antimicrobial_copper-alloy_touch_surfaces
Location, New hospital tower Sutter Health Oakland CA 2012
Those are just the items I did mention in the above article to reduce HAI.
However, if requested I could prepare a more professional document on the entire topic including my multiple years of both  observed experience with HAI as an architect/project manager for medical projects, and First hand experience when my wife nearly died from an HAI following the birth of our first child. There are many glaring issues with how this occurred, before and after we have documented and would be glad to overview in detail. Most have to do with human error and very poor policy and procedure outside the ICU. Once I made a very large "scene" about how close my wife was to expiring and we received ICU level protocols for her care her condition improved and we were released within 48 hours.
The staff DOES know what to do, they simply fail to do it, either by lack of good policy, or forgetful/willful disobedience to their training, on a case by case basis.
 
Given that medical mistakes are now the 3rd lead cause of death in America, I STILL maintain, correcting HAI is among the leading "Fixes" for the American Health care System.
Consider that here we have licensed healthcare professionals, in a licensed and regulated healthcare facility, and the primary way you may dies is due to human error;
AND the healthcare professionals 'Charge of Duty" is to
"First Do No Harm"
 
Imagine if we apply the failure rate of medical professionals interaction with the public to my profession of architecture.
Our Charge of duty is
"To protect the health safety and welfare of the public in the built environment"
This topic is the mainstay of our continuing education requirements in most states.
BUT, consider:
What if every time you entered a medical building designed by an architect, errors of the architect could cause you to have a 20% chance of serious illness, injury or death?
What if in this case the individual architects working on this had no personal/professional responsibility for these errors and were shielded by unions and the  design firm they worked for.
Its simply not the case. Architecture for medical f
Doug Plumb Added Mar 8, 2018 - 6:24am
re "AND the healthcare professionals 'Charge of Duty" is to
"First Do No Harm"
 
Most do not take the Hippocratic Oath. Its not a requirement in Canada. Its optional.
Pardero Added Mar 8, 2018 - 3:37pm
Douglas Clark,
I am impressed with your competence and hands on experience with this issue. Your outstanding rebuttal is every bit as informative as your fine 'article'. 
I can only hope that the right eyes read this, take it to heart, and take action.
I suspect that you have much much more to offer on this subject and others.
Thomas Sutrina Added Mar 8, 2018 - 7:00pm
Douglas Clark, welcome to WB.   You didn't really say how to fix healthcare in America.  You told us some of the problems.  That is OK.
 
Douglas,  Dr. Milton Friedman has an article showing two by two possible combinations.  On one axis 'Who's money is being spent: yours, someone else's.  On the other axis 'On whom is the money spent: you, someone else.
 
So Douglas and other examine health care by this 2x2 matix to discover the problems and direction of solutions.   So some of the money is yours and some is someone else's money But like a tax in effect it is only tangentially your money since you have not real control of it.  The money is in effect someone else's money.
 
This money is being spent by someone else.  You make a little decision in realizing that you need medical care but once that is made your participation is minimal.  The medical professionals tell you that your do not know enough to make intelligent decisions.  At best you get to pick a path that the professionals then move down.  Do you know the cost of each path or even who is the most cost effective provider.  Not likely.  Someone else determines what is purchased, at what cost, and how it is presented to you to be the absolute most confusing.  And they determine the interest and all other cost decisions.   Those that are doing the paying with your or the system's money try to maximize cost up to the maximum you will bear so they make the most profit.  
 
With Obamacare or any national health care system reduce cost.  Well the present system has all the features of national health care.  Everyone pays into a pool so in effect someone else's money is being spent.   And the professionals determine the health care received so someone else is spending the money.  The system will meet the needs of the people in the system not the patents.  That is what can be seen in the VA which is a national health care system.
 
Your purchasing a blob your money is being spend by someone else. 
Thomas Sutrina Added Mar 8, 2018 - 8:13pm
Douglas the solution is to move as much into the other blocks of the 2x2 matrix.  Health savings account is a means of having you decided how to spend your money.   For the poor it would be better to provide a health savings account with a fixed amount of money that a person would put in themselves if they could.  Cataphoric insurance like we have for cars and homes would be cheep.  
 
Doctors are the experts.  But the free market seems the apply spontaneous order to find great solutions.  And those that make up the group are not experts.  But as shown with products people are experts on finding out how something has performed and its value.  Health savings account will be used more then large item purchases so we can expect similar results.   The Japanese cars for example lasted 8 to 12 years to American cars 5 to 8 years.  People figured that out and American car makers got the message by falling sales and matched the Japanese quickly.  Hospitals and doctor will get the message also quickly that performance is measurable by the patents.
 
Health saving account is just one method of getting into spending your own money element of the matrix.  Other better solutions may be better.
 
Check this out by Dr. Friedman on welfare: https://wichitaliberty,org/economics/friedman-the-fallacy-of-the-welfare-state/
 
Category I, your spending your own money on yourself.
 
Category II, your spending your own money on someone else.
 
Category III, your spending someone else's money on yourself, lunching on an expense account, for instance.
 
Category IV, your spending someone else's money on still another person.
 
All welfare programs falls into either Category III or Category IV.  Category IV programs share one feature of Category III, namely, that the bureaucrats administering the program partake of the lunch; and all Category III programs have bureaucrats among their recipients.  The lure of getting someone else's money is strong.  The temptation to engage in corruption, to cheat, is strong and will not always be resisted or frustrated.  The bureaucrats administering the programs will press for better pay and perquisites of themselves, an outcome that larger programs will facilitate.
 
Legislators vote to spend someone else's money. The voters who elect the legislators are in one sense voting to spend their own money on themselves, but not in the direct sense of Category I spending.  The Connection between the taxes any individual pays and the spending he votes for is exceeding loose. In practice, voters, like legislators, are inclined to regard someone else as paying for the programs the legislator votes for directly and the voter votes for indirectly. Bureaucrats who administer the programs are also spending someone else's money. Little wonder that the amount spent explodes.
Flying Junior Added Mar 9, 2018 - 5:59am
What was wrong with the republican plan from 2008?
 
Don't get sick.  If you do get sick, die quickly. 
 
It's been working fairly well so far.
Logical Man Added Mar 11, 2018 - 1:02pm
The best fix for healthcare is in the hands of individuals.
Eat well, exercise and get enough sleep.
A few beers and a few bowls won't hurt.
You don't get HAI if you don't go into hospital!
Nice to know they are there when you need them, though.
Last time I was in one (briefly) was after a mountain bike crash, with broken ribs and damage to liver and spleen.
I'm 63 and can out-bike most people half my age. No issues with weight, heart, cholesterol or blood pressure.
As they say in UK, an ounce of prevention is worth a pound of cure.
Funding issues are a huge issue, particularly in US, which spends about as much in 5 hours on 'defence' as it does on healthcare in 5 years. I see a potential fix there.
 
Frosty Wooldridge Added Mar 11, 2018 - 10:03pm
Simple way to fix health care: this entire population needs to eat organic, avoid dairy, avoid meats, avoid pizza, coke, Big Macs, junk food, all soda pop, processed foods in cans, bottles and packages.  You either eat and exercise toward your own health, or you become a fat slob like 7 out of 10 Americans that don't care a twit about their health until they are too far gone.   You either eat to live or eat to get sick.  It's a choice and most Americans eat to die early. 
Leroy Added Mar 11, 2018 - 10:06pm
Excellent article and followup.
 
As a recipient of HAI, I would like to see solutions and actions.  I'm not sure what kind of games the hospitals are playing.  Post-surgery, I had a nasal swab and the result was positive for MRSA.  Two pre-surgery swabs showed no presence.  An orange/red sign was posted outside my room.  Doctors seemed to ignore it.  The biggest issue I had was getting my meals after that.  They had to suit up to bring me my meals.  They just skipped bringing the meals until I complained enough.  A few months ago, I requested my medical records.  There was no record of a post-surgery nasal swap nor anything that indicated I ever acquired MRSA.  I suppose it is possible they made a patient mistake.  I'll find out soon.
 
Now I am facing revision surgery due to an unidentified infection.  It can't be cost-effective not to take the necessary precautions.  Maybe it is on the patient's nickel and the doctors just don't care.  
Pardero Added Mar 12, 2018 - 3:14am
Leroy,
Sorry to hear that. I wish you could sue the bastards. Only financial pain will make it cheaper for them to do the right thing. Good luck on your revision surgery. 
Pardero Added Mar 12, 2018 - 3:16am
Douglas Clark,
Could you become a high dollar consultant and clean up these crummy hospitals while making a good living?
Leroy Added Mar 12, 2018 - 12:00pm
Thanks, Pardero.  Hospital acquired infections are risks you take when you enter a hospital for surgery.  You have to prove negligence.  In the absence of knowledge otherwise, I accept that the doctor followed procedure.  Stuff happens.  Both the doctor and the PT made a huge mistake, which may have caused the infection.  My distaste for lawyers prevents me from pursuing it further.  
As I type, I am waiting for my pre-op screening.  I suppose I will find out soon if I truly picked up MRSA during my last operation.
George N Romey Added Mar 12, 2018 - 2:59pm
I’m 58. Haven’t seen a doctor in 20 years and only hospitalized once when I was 4 years old. I usually treat myself. Sounds like I’m not missing anything good.
John Minehan Added Mar 12, 2018 - 3:01pm
He raised some good points that are not raised enough.  Also, he has an interesting point of view coming from it from an architectural/facilities vantage point.
John Minehan Added Mar 12, 2018 - 3:36pm
"Hospital acquired infections are risks you take when you enter a hospital for surgery.  You have to prove negligence."
 
Very true.
 
On the other hand, the hospital (and its infection control, CQI/TQM people and M&Ms Committee) should  be moving heaven and earth to figure out what happened and how to avoid it recurring . . . .