5 ms·

In your opinion, what would be the lowest hanging fruit that could be changed to have the largest positive impact?

duffpkg 4y ago
People are rarely satisfied with this answer but its demonstrably true and was proven time and time again at the facilities ClearHealth managed. 1) Feverent, almost religious, adherence to hand washing. 2) No neck ties or dangly sleves whatsoever in buildings that house patients. 3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Those are simple, virtually free, things that have a very meaningful impact on outcomes. Some of the most viscous fights I've had with hospital boards were over what amounted to the "uglier look" of copper/brass. It is an extremely unpopular topic in healthcare but the area that takes a lot of effort to solve but also has a tremendously out-weighted benefit is reducing preventable medical errors. My opinion after being in healthcare ~20 years is that preventable medical error is absolutely in the top 3 causes of death in the US. The easiest subset of it to resolve is prescription related errors, we have all the tools to resolve those but not the will.
- linkdink 4y ago
  Well, I'm satisfied with that answer. But maybe that's because I think brass and copper look better than stainless steel.
- BitwiseFool 4y ago
  >"3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Because of the pandemic I started encountering doors that have a shoe pull, where you can use your foot to open the door instead of having to touch the handle. I really hope these catch on, but they are still quite rare.
  - snuxoll 4y ago
    Also stop getting rid of paper towels if you still have manual faucets. Nothing grosses me out more than going to a public restroom with only air dryers, but manually operated faucets that now require you use clean hands to turn off after you turned them on with presumably dirty hands.
    - themaninthedark 4y ago
      Use your elbow to turn off the faucet(as long as it is lever type, if twist type then good luck). I want paper towels for the door knobs/pulls and the trash can should be located near the door so I can throw it out after opening the door.
      - stackbutterflow 4y ago
        Or make the door push to leave, pull to go in. I don't understand why it's not a thing.
        themaninthedark 4y ago
        Bathroom doors are usually off a small hallway, sometimes a busy one. By design, they don't have windows. So you run the risk of hitting people with the door. Also, you will still need to interact with the door to open the lock. Having a door that unlocks if you push on it would be a bad thing for people who use the bathroom with their children.
    - bombcar 4y ago
      Just like the door foot things, you’re supposed to Bruce lee the faucet afterwards and turn it off with your foot.
- haberman 4y ago
  > Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". I have never heard of this. I had to Google it to even understand your meaning. It's eye-opening to learn that different metal surfaces have an effect on the spread of germs.
  - Ballu 4y ago
    Could you post some good links you read/browsed? Google is providing too much junk and difficult to reach any high level conclusion.
    - astura 4y ago
      https://en.wikipedia.org/wiki/Antimicrobial_properties_of_copper https://en.wikipedia.org/wiki/Antimicrobial_properties_of_co...
  - bombcar 4y ago
    Copper is a well-known drain additive to kill roots.
- galangalalgol 4y ago
  What about the incentive for non profit hospitals to grow so that they can better compensate leadership, resulting in capital that must be spent on facilities and equipment to retain non profit status. Leading to a spiral? It is hard to compare details of the systems and outcomes across countries, but surely we can find where the money apent ends up? Construction firms? Doctors? Equipment manufacturers? Hospital administration?
  - pc86 4y ago
    Is there a rule that says a certain percentage of revenue must be spent on a facility to retain non-profit status? It can be spent on equipment and salaries, both of which would benefit much more than upgrading the building to no patient care benefit. This is anecdotal but the number one complaint I've heard from physicians about patient care is facilities being run and and managed by non-clinical MPH/MHA "business types" whose primary focus is almost invariably cutting costs, increasing physician workloads, and fighting salary increases tooth and nail.
    - sgent 4y ago
      No, but there is a "rule of thumb" that a hospital will prefer private insurance patients to medicaid patients (due to reimbursement), and private insurance patients will go to hospitals with newer and nicer facilities. If you want the elective hip replacement patient, then having a newly remodeled orthopedic ward / office building is critical. Patients probably can't tell one doctor or nurse from another, and hospitals don't advertise on actual quality measurements like staffing ratios...
- caskstrength 4y ago
  > Those are simple, virtually free, things that have a very meaningful impact on outcomes. Some of the most viscous fights I've had with hospital boards were over what amounted to the "uglier look" of copper/brass. Am I the only one who finds copper/brass much more aesthetically pleasing than plain and boring stainless steel?
  - majani 4y ago
    It was most likely a retrofitting discussion. Copper doesn't blend with modern designs and color schemes so retrofitting it would be ugly
kolbe 4y ago
I've been told credential easing is by far the easiest one to implement. Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them. That's 10-20% more time working for existing doctors, and who knows how many more people would enter the profession. Nurses could be empowered to make doctor lite decisions very easily.
- pc86 4y ago
  > Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them. Where in the world did you hear this? Don't trust anything else that person told you. Aside from some low-income clinic hours for certain specialties (which is objectively a societal good, not to mention typically specific to a given specialty, e.g. OBs have an OB clinic not primary care) no doctor is spending 6 years of "excess schooling residencies" learning anything. Med school is 2 years of classes then 2 years of rotations where the students - who aren't yet doctors - do 4-12 weeks of rotations through various core and elective specialties. After they graduate they're now doctors but have 3-6 years of specialty-based residency training where for 80-100 hours a week, 50+ weeks a year, they do nothing but their specialty. ACGME limits weekly hours to 80 (I think over a 2-3 week average), but 90% of the doctors I know said they regularly broke that and just didn't log the extra time. Especially in surgical residencies, all you're doing is your specialty-specific stuff during that period of those.
  - kolbe 4y ago
    > Don't trust anything else that person told you. You just said what he said, but with emphasis on 100 hour weeks for years on end being good instead of bad. Why did you disagree with me, then go on to list how much doctors work before the get to practice on their own? His point was they get too much training, with much of it being irrelevant (not all). If you're this angry and reactive, you really shouldn't be a doctor. People here seem to love the NHS. In the UK, doctors are not forced to study something irrelevant for four years in college, then do med school, then do a 4 year residency (i.e. age 30). They are often done by age 24, and ready to help.

People are rarely satisfied with this answer but its demonstrably true and was proven time and time again at the facilities ClearHealth managed. 1) Feverent, almost religious, adherence to hand washing. 2) No neck ties or dangly sleves whatsoever in buildings that house patients. 3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Those are simple, virtually free, things that have a very meaningful impact on outcomes. Some of the most viscous fights I've had with hospital boards were over what amounted to the "uglier look" of copper/brass. It is an extremely unpopular topic in healthcare but the area that takes a lot of effort to solve but also has a tremendously out-weighted benefit is reducing preventable medical errors. My opinion after being in healthcare ~20 years is that preventable medical error is absolutely in the top 3 causes of death in the US. The easiest subset of it to resolve is prescription related errors, we have all the tools to resolve those but not the will.

linkdink 4y ago
Well, I'm satisfied with that answer. But maybe that's because I think brass and copper look better than stainless steel.
BitwiseFool 4y ago
>"3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Because of the pandemic I started encountering doors that have a shoe pull, where you can use your foot to open the door instead of having to touch the handle. I really hope these catch on, but they are still quite rare.
- snuxoll 4y ago
  Also stop getting rid of paper towels if you still have manual faucets. Nothing grosses me out more than going to a public restroom with only air dryers, but manually operated faucets that now require you use clean hands to turn off after you turned them on with presumably dirty hands.
  - themaninthedark 4y ago
    Use your elbow to turn off the faucet(as long as it is lever type, if twist type then good luck). I want paper towels for the door knobs/pulls and the trash can should be located near the door so I can throw it out after opening the door.
    - stackbutterflow 4y ago
      Or make the door push to leave, pull to go in. I don't understand why it's not a thing.
      - themaninthedark 4y ago
        Bathroom doors are usually off a small hallway, sometimes a busy one. By design, they don't have windows. So you run the risk of hitting people with the door. Also, you will still need to interact with the door to open the lock. Having a door that unlocks if you push on it would be a bad thing for people who use the bathroom with their children.
  - bombcar 4y ago
    Just like the door foot things, you’re supposed to Bruce lee the faucet afterwards and turn it off with your foot.
haberman 4y ago
> Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". I have never heard of this. I had to Google it to even understand your meaning. It's eye-opening to learn that different metal surfaces have an effect on the spread of germs.
- Ballu 4y ago
  Could you post some good links you read/browsed? Google is providing too much junk and difficult to reach any high level conclusion.
  - astura 4y ago
    https://en.wikipedia.org/wiki/Antimicrobial_properties_of_copper https://en.wikipedia.org/wiki/Antimicrobial_properties_of_co...
- bombcar 4y ago
  Copper is a well-known drain additive to kill roots.
galangalalgol 4y ago
What about the incentive for non profit hospitals to grow so that they can better compensate leadership, resulting in capital that must be spent on facilities and equipment to retain non profit status. Leading to a spiral? It is hard to compare details of the systems and outcomes across countries, but surely we can find where the money apent ends up? Construction firms? Doctors? Equipment manufacturers? Hospital administration?
- pc86 4y ago
  Is there a rule that says a certain percentage of revenue must be spent on a facility to retain non-profit status? It can be spent on equipment and salaries, both of which would benefit much more than upgrading the building to no patient care benefit. This is anecdotal but the number one complaint I've heard from physicians about patient care is facilities being run and and managed by non-clinical MPH/MHA "business types" whose primary focus is almost invariably cutting costs, increasing physician workloads, and fighting salary increases tooth and nail.
  - sgent 4y ago
    No, but there is a "rule of thumb" that a hospital will prefer private insurance patients to medicaid patients (due to reimbursement), and private insurance patients will go to hospitals with newer and nicer facilities. If you want the elective hip replacement patient, then having a newly remodeled orthopedic ward / office building is critical. Patients probably can't tell one doctor or nurse from another, and hospitals don't advertise on actual quality measurements like staffing ratios...
caskstrength 4y ago
> Those are simple, virtually free, things that have a very meaningful impact on outcomes. Some of the most viscous fights I've had with hospital boards were over what amounted to the "uglier look" of copper/brass. Am I the only one who finds copper/brass much more aesthetically pleasing than plain and boring stainless steel?
- majani 4y ago
  It was most likely a retrofitting discussion. Copper doesn't blend with modern designs and color schemes so retrofitting it would be ugly

kolbe 4y ago

I've been told credential easing is by far the easiest one to implement. Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them. That's 10-20% more time working for existing doctors, and who knows how many more people would enter the profession. Nurses could be empowered to make doctor lite decisions very easily.

pc86 4y ago
> Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them. Where in the world did you hear this? Don't trust anything else that person told you. Aside from some low-income clinic hours for certain specialties (which is objectively a societal good, not to mention typically specific to a given specialty, e.g. OBs have an OB clinic not primary care) no doctor is spending 6 years of "excess schooling residencies" learning anything. Med school is 2 years of classes then 2 years of rotations where the students - who aren't yet doctors - do 4-12 weeks of rotations through various core and elective specialties. After they graduate they're now doctors but have 3-6 years of specialty-based residency training where for 80-100 hours a week, 50+ weeks a year, they do nothing but their specialty. ACGME limits weekly hours to 80 (I think over a 2-3 week average), but 90% of the doctors I know said they regularly broke that and just didn't log the extra time. Especially in surgical residencies, all you're doing is your specialty-specific stuff during that period of those.
- kolbe 4y ago
  > Don't trust anything else that person told you. You just said what he said, but with emphasis on 100 hour weeks for years on end being good instead of bad. Why did you disagree with me, then go on to list how much doctors work before the get to practice on their own? His point was they get too much training, with much of it being irrelevant (not all). If you're this angry and reactive, you really shouldn't be a doctor. People here seem to love the NHS. In the UK, doctors are not forced to study something irrelevant for four years in college, then do med school, then do a 4 year residency (i.e. age 30). They are often done by age 24, and ready to help.