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Hospital reform is coming

Hospitals have always been dangerous places. But changing procedures has always met with aggressive resistance from medical, business and political circles. Florence Nightingale revolutionised Victorian hospitals by throwing out untrained and often drunken women, scrubbing clean hospitals, demanding strict personal standards, introducing routine and order and giving patients  good nutrition, clean dressings, fresh air. The Sanitation Movement of the nineteenth century brought in hand washing, sterilisation of equipment. Human and animal was removed from the public water system and housing regulations stopped over crowding. Life expectancy doubled and infant mortality dropped.

What a welcome change that would be to many Australian hospitals. Public hospitals can be overrun with end of life patients, homeless patients, psych patients, people who should have had ongoing community care. Some emergency departments resemble a zoo. Private hospitals are no better. They can be nothing more than a glorified hostel with a trendy coffee shop, no doctors on site, unskilled, casual nurses and no acute back services. If the patient gets ill, they just call an ambulance and take the patient to a public hospital.

Many private hospitals simply refuse to treat complex patients, no matter how many years they have faithfully paid high insurance premiums. Instead they ‘cherry pick’ the simple cases and push sick patients back to the public system. Meanwhile politicians blame each other and kick patients from state to federal funding.

The move to health transparency is growing. Many new doctors and nurses see the secrecy over hospital errors as ridiculous, out of date and harmful. ‘I didn’t take up medicine to join a culture of secrecy’ said Dr Marty Makary.

The causes of hospital errors are many, but the main issues are fragmented, incomplete and often inaccurate medical records. Staff often have incorrect information about patients history, medications and pathology reports. The decisions made about patient care is often based on inaccurate data. Most patients have never even seen their own records.

Staff training and ratios vary dramatically from hospital to hospital. In public hospitals some attempt is made to quantify and monitor staff’s skills levels. In private hospitals doctors and nurses work on a contract basis, are expected to ‘maintain their own professional standards’ and there is very little actual checking done.

There is no incentive for hospitals to improve their clinical standards. Hospital errors are recorded but the results are kept hidden from the public who  go into hospitals blind to their history of errors and complaints. No hospital funding is based on the actual standards of care given to patients. Funding is passive, ‘fee for service’ and ‘tick and flick’. Bad and good hospitals are funded in an identical manner.

Enter heath startups. A new wave of companies are determined to disrupt the antiquated, secretive, error prone and over priced health industry.

References

Covering your local hospitals: assessing the tools – ProPublica
Nineteenth century sanitation reform – eNotes
Patients could be casualty of 57 billion hospital shortfall – The Age
Care Home – wifi for residents – UK
Guroo – the steps and cost of healthcare
Pokitdok – health data
ClearHealthCosts – cost of healthcare
Dr Foster – hospital analytics
Osler – hospital performance

Wikihospitals 2015