Who Owns the Patient Outcome? We All Do!

June 18, 2012

By Mary Ellen Fortenberry

Editor's note: This article originally appeared in the June 2012 print issue of ICT as the Vendor Viewpoint column.

In today's ever-changing healthcare environment, patients demand more advanced procedures and equipment that take the pain and recovery time out of surgery. While they seek these advancements, they have forget how complicated it is to clean, inspect and test this advanced equipment. However, navigating a path through our consumer marketplace, we cannot go for a drive without seeing billboards advertising the latest and greatest robotic 3D surgery. The consumer demand for more advanced surgery has transitioned into an expectation.
Friends and relatives often ask what surgeon, hospital, equipment, etc. is the best; no one has ever asked about the other associated risks. Also, no one has ever asked, Who has the best instruments? or who has the best process? One might say Well, all surgery has risks, and I would agree.

A few months back, The Today Show aired a segment focusing on surgical instrumentation and the professionals who clean them. This segment allowed a peek behind the curtain suddenly, it was like a cloud was lifted and this was the first time anyone had discovered the challenges of cleaning, inspecting and testing instrumentation. A vast majority of the time instruments are not cleaned by certified or even licensed professionals. For as many doctors shows on TV, from The Doctors to the Dr. Oz show, talking about the things you can see, however, it is pertinent to recall how much you cannot see!

The chances of SSI are increase and become more likely by adding more advanced instrumentation. This is due to the lengthy and tedious cleaning process. A typical robotic instrument, a single instrument, will take 45 minutes to clean properly. Given the high costs of these instruments, many hospitals cannot afford the additional cost of multiple instrument sets. Fiscally, robotic surgery by itself barely breaks even for the hospital; this often translates the importance of securing a larger quantity of patients. With patients expecting advanced surgical treatment and hospitals limited due to the lengthy process required, who is expected to cut corners and speed the process up in order to get another surgery on the board? More importantly, what are the associated risks with this practice and where do they fall?

As healthcare professionals it is our responsibility to maximize patient outcomes. Sure, folks have been talking about this for years. However, what I have seen is disregard for what you do not. How often is a set cleaned and flashed in the operating room by a well-intentioned professional who does not know the proper cleaning and sterilization method?

Major upheaval requires authenticity and integrity on the part of all participants especially we as healthcare professionals. Most change efforts do not fail from lack of concepts or but from lack of description of how to do it right. Empowered, knowledgeable people do the right thing. Are we empowering each other with that? I would submit that we are not.  We are not truly partners in the real sense of the word.

We are experiencing a period of cultural distortion in which everything we have learned and practiced is adapting. The response we are all having to this varies to a great degree; some embrace it others see no value in changing.
We, as healthcare providers, own the process be it good, or bad.

We need to challenge each other, as good partners do. This does not mean that one party gives in to the other; it means we create a culture that not only drives great patient outcomes it demands it! The patient can no longer be the scapegoat, we are the patient!

Revitalization and accountability is where we are now. We are learning new skills, trusting each other, and challenging each other to do the right thing. This is extremely difficult because we need to unlearn some very old and very bad habits. The corners can no longer be cut.

An organic organization is one in which everyone takes responsibility for the success of the whole "patient outcome." If we are to influence each other, it should be based on trust an understanding that the patient outcome is dependent on all participants. When we do not "walk the walk," we undermine every stage in the sterile process. Causes of misfortune, or poor patient outcomes, are often due to a lack of proper direction, education, application and leadership.

A crisis in healthcare already exist (e.g., access, payment, quality and delivery). It is time to own our part as healthcare providers, regulating bodies, vendors and customer partners" in order to provide the solutions that demonstrate the best patient outcome. Customers demand solutions, not standard products. Customers problems related to the lack of staff, education, capital, resources, benchmarking, and quality standards.

The U.S. hospital system is in a state of transition. Hospitals face daunting challenges; such as evolving technologies, reimbursement policies, demographic trends, competing fiscal demands, and a worsening workforce shortage.
Reconsideration of hospital design and workflow processes holds great potential to improve the efficiency and effectiveness of care delivery in the foreseeable future. Bold changes in the hospital work environment are imperative to ensure sustainability and affordability of the American healthcare delivery system.

Sterile processing personnel are the foundation of a patient resource; maximizing the efficiency and effectiveness of these professionals is essential to the integrity of hospital surgical function and the promotion of safe, quality patient care.
A model for change must be embraced by the customer, regulating bodies, manufacturing and vendors at all levels. This is a change in behaviors and culture; to be successful we must reflect on ourselves. I am fortunate to work with a great group of folks, regulator, manufactures, and customers, which are all demanding change! Together we are forging the future of healthcare. What does that mean? It means great patient outcomes, competitive advantages, openness to improvements and change, and trust that the good of the patient will be archived by the whole organization organically.

It is time we all own up to our responsibilities by being a participant on our team. Empowering all of us with the knowledge and be willing to adapt by applying the knowledge that we possess to drive a better future for us all.

Mary Ellen Fortenberry is director of field service for PREZIO Health.