Wednesday, July 23, 2014

Why Can't We Make It Easy?

I've become a believer in the idea of "make it easy to do it right." Which means that when I want to do something, say, for example, keep my dining room tidy, then I should make it as easy as possible. That could mean getting rid of a few items to reduce clutter, or it could mean organizing my storage areas so that it is easy to put things away, or it could mean diverting my pathway into the house so I don't automatically dump my bag on the dining room table as I walk in. It's not that there is a particular right way, but that overall the path of least resistance tends toward a tidy dining room. I harness my own laziness by setting up good default options.

I've heard this idea at work as well, that the best road to safe and high quality patient care leads through this territory of creating systems that default to actions and choices with the best evidence behind them, and then improve on those systems in iterative fashion based on outcomes so that the defaults become better and better. It's a great idea but I don't think my job actually believes in it.

I sat through a meeting today with about thirty other people. The goal of the meeting was to educate us about a particular problem that preventing our senior leaders from accurately measuring how much work we are doing. This is a big deal in these days of minimal resources, so we want to try to fix this problem so that we can hang on to our manpower and space. The meeting took over an hour of time. From my perspective the only bright spot was that the speaker seemed genuinely enthusiastic about her work in extracting information from a huge database and making it useful. She was beaming as she talked to us and seemed close to bouncing with delight a few times. It's not the kind of task that I personally enjoy but it was cute to see how happy it made her to have created this tracking tool and to share it with us.

I'm glad there was one bright spot because I found the content of the meeting discouraging. The gist of what I took from the meeting is that the biggest source of the problem is our electronic medical record, which causes providers to mislabel their work with outdated numerical codes instead of using the new mandatory codes. Apparently at times it even switches out the providers' entry of the new codes for the old codes, without notifying the provider. These codes are a way for medical work to be measured, and they have to be correct to go into the large database that leadership uses to evaluate work. So every patient visit with an incorrect code is lost from the perspective of counting work. Thanks to our goofy computer system we apparently have hundreds of hours of work that just don't count.

This just seems really silly to me. Ideally, an electronic medical record system would help providers be more accurate with tasks like assigning the correct codes to a particular kind of work. I'm not a computer person and I don't know much about systems or programming. From my naive end user perspective though, it would make sense to me to only put correct options into the system in the first place. If you only offer correct options then you are making it easy for health care providers to complete the task correctly. The default answers will be the right ones. It makes no sense at all to have a system that offers wrong and outdated codes as the default options months and months after the change has taken place. It is really foolish to have a system that swaps out correct codes for wrong ones. It's the exact opposite of making it easy to do it right.

Really, it's very discouraging.