A family medical emergency has required a lot of my attention and time this past week, including a short-notice trip to my inlaws in Midland, Michigan. Some of you may know about Midland, a rather unique small town with a couple of major employers: Dow Corning and Dow Chemical. Dow, and the Dow family members, have been exceptionally generous to the town, which thanks to them has top notch schools, arts centers, and medical facilities.
My father-in-law was admitted to the Mid-Michigan Medical Center, which has received several national awards for clinical excellence. During his two week stay the quality of actual clinical activities appeared to be excellent as expected. But a few incidents irked, and then angered the customer-centric lean guy in me.
There were small incidents with the food menu, receiving shots, and physical therapy. But that paled in comparison to our experience this past weekend. On Friday morning the hospital decided that it had done everything possible for my father-in-law, and the "social worker" (you’ll soon see why this is a misnomer) called us to arrange a discharge to an assisted living center for further recuperation and therapy.
She gave us an hour.
An hour to visit three facilities at different ends of town, evaluate them, and arrange for admitting. On a Friday afternoon at 3pm, only a couple hours after we had to deal with the news that the brain tumor was probably inoperable. In that state of mind my mother-in-law and my wife had to rush around frantically in an attempt to make this very difficult decision. In the meantime the hospital had gone ahead and fax’d discharge information to all three facilities to speed up the process. Luckily my wife told a nurse at one facility about what the hospital was doing to us and she told us that we really had to agree to a facility before the hospital could do anything. With this in mind we chose a facility that had an opening on Monday, and notified Larissa. She continued to badger my wife about needing an immediate discharge, but with her new knowledge my wife pretty much told them it would be Monday, period.
I can understand the business side of the hospital’s story: they had an influx of patients to accomodate, and needed the room. But who is the customer? The shareholders of the hospital, or the patient? I think most of us would argue the patient.
Mid-Michigan Medical Center has worked hard for a high quality image. They are very proud (judging from the numerous banners, some signed by many employees) of their awards. But their future success will be driven by the experience of their customers. Perhaps a little constrained due to healthcare supply limitations and the complexities of insurance plans, but over time the market will still prevail.
Bill Waddell recently wrote a great post on "Looking Versus Being" [Lean]. The same concept applies to excellence. It is relatively easy to look excellent, but being excellent, especially in the eyes of your true customers, is another matter.
George W says
Wow… great story. Even with that I strongly believe that market-based healthcare is far better than single-payer. We often hear about how great the Canadian or Swedish single-payer system is, but when you dive a little deeper you realize that the citizens in those countries are actively trying to change things to allow more privatization. Due to the long waits (almost two years for prostate surgery in Sweden, six months for an MRI in Canada), wealthier individuals often go to the United States. That simply aggravates the problem by dividing even more the quality of care between the “haves” and “have nots”. The Canadian supreme court just recently issued a ruling that will allow private healthcare for the first time.
Market-based healthcare will work… but we also need to find a way to reduce the obscene amount of paperwork and situations like you describe. I’m personally convinced this is due to partial regulation, which protects (or delays) the market impact of poor service.
We need to look at this more.
juanita perlman says
i know nothing about the topics you talk about but i came across this post while searching on midmichigan hospital. i had the same thing happen to me there last month. i had to yell and scream. i liked the nurses and i thought they did a good job but this made me very mad. its too bad they do this and hurt their patients and families.
Bill Waddell says
Of all of the things Henry Ford said, “Profit is the inevitable conclusion of work well done” strikes me as the most profound. Who knows what was going through the mind of the sometimes brilliant, sometimes crazy old coot when he said it, but to me it answers Kevin’s rhetorical question concerning whether the hospital’s first goal should be to please patients or stockholders. The best way to take care of the stockholders, in the long term, is to take very good care of the patients in the short term.
It seems to me that one consequence of the current thinking in American management that the top decision makers should be primarily financial people and folks schooled in managing by ratios and statistics, is that we are too often led by people out of touch with the work. I can envision the hospital having some metric that can be optimized by turning beds over; or making sure that no beds are occupied by people who are not scheduled for further treatment. Such metrics begin with a profit requirement, then determine how much (or more often how little) service can be given to still be profitable. Incredibly insensitive decisions, such as that to evict Kevin’s father in law on one hour’s notice, are driven by such metrics.
I believe Ford was saying that it is fundamentally wrong to begin with profit, then calculate how much value can be given in order to maintain that profitability goal. Instead, the hospital, and everyone in business, must begin with the work – and do it very well – then trust that if the work is well done in terms of cost and quality, profit will inevitably follow. In short – customers will pay for efficient, high quality work.
If nothing else, the managers of every business should take a serious lesson from this event. You just never know when the customer you abuse might be the father in law of a guy who is in a position to shine the ugly light of truth about your crappy service levels in a web site read by 46,000 potential customers!
Bill Waddell says
And while we’re at it, let’s hear it for the nurse that gave your wife the honest advice. Whether it is hospitals or care facilities, people who are willing to give straight information concerning patient’s rights are becoming a rarity.
Mitch McDonald says
Its sad to see what could have been a positive customer experience tarnished severely by the actions or policies of a single person.
Julia says
Amazing and sad. I’ll say a prayer for your father in law, and also for anyone else with the misfortune to end up at Mid-Michigan Hospital. It sounds like a potentially good place with a few bad policies.
Del Meyer says
What Kevin is seeing here is Not Market Based health care but corporate socialized medical mentality of Managed Care. Kevin’s FIL may not even have had an HMO but since three-fourths of health care is now Managed Care of some sort, the hospital mentality of Managed Care carries over into the private care section. I’m sure we’ve all done this before we realized that the HMO constraints don’t apply in a particular case.
In a free market with perhaps a 10% hospital copayment, the patient, Kevin’s FIL and his family, would be making a market based decision. Would getting into the right care facility three days after acute care is no longer necessary be more important than saving 10% of a say $2,000 hospital day. I would certainly be willing to pay an extra $200 dollars to make sure my loved ones were in the facility with the best nursing care.
With Managed Care, the hospital makes no additional money for keeping Kevin’s FIL there another three days because they get paid a fixed fee per admission, whether five days or twenty, based on the diagnosis.
I don’t believe the public has any concept of the pressures the non-medical hospital bureaucrats, whether Medicare or HMO, place on the doctors and nurses when a non-medical based decision for discharge is reached.
There is no market based decision here, and the feces hits the propeller when the corporate socialized plan makes a solo financial decision and they don’t care if the dung spreads over the entire city of Midland, including three care facilities.
What Kevin’s family is experiencing would not happen in the open Medical MarketPlace where everyone would be happy with everyone else’s freely made decisions.
Great Example.
Del Meyer, MD
Pulmonary Medicine
Editor and Founder
MedicalTuesday.net