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.
>"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.
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.
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.
> 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.
> 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?
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?
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.
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...
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.
> 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.
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.
One thing that makes conversations with doctors about regulations around board certifications easier to understand is that anybody who is currently a doctor in the US is heavily disincentivized from improving or changing the system in any way. The absurdly onerous restrictions on becoming a doctor work to the benefit of current doctors by artificially restricting supply and thus keeping wages high. Why would doctors want to get rid of those very regulations?
I'll be more clear - doctors have almost no extra or unnecessary training during their residencies. It's all very specialty-driven, or at the very least is specialty-specific public service (e.g. low-income clinics). If anything, the doctors I've spoken to said they should all probably be a year or two longer across the board if only to allow for better work-life balance, but none of them would want to have to go through that obviously.
The closest thing to "extra training" they get is fellowship-related rotations, but even this is all things they'll see in practice so they need to know how to handle it initially, if for no other reason than so they know when to offload it to a specialist.
> They are often done by age 24, and ready to help.
I'm sure this is fine for whatever the equivalent is to an urgent care doctor in the UK (bottom of the barrel family med in the US, probably not board certified - e.g. failed the exam or not qualified to take it - or doing transitional residency because they didn't match anywhere), but I'm not really interested in my orthopedic surgeon or neurologist just getting through their training as quickly as possible.
There are lots of ways the US could increase the pool of doctors, and most doctors are probably paid way too much (paradoxically, probably most egregiously at the low end of skill), but "cut out a bunch of training" is a dumb way to do it.
You realize that 4 years of residency isn't the magical number of the perfect amount? Two could very well be sufficient, and the other two "extra or unnecessary training." Also, you keep ignoring the college requirement, which makes you seem very disingenuous, and if you are a doctor, makes me worry for your patients.
I'm not a doctor, but why would you want a doctor who didn't go to college?
I was pre-med in college and quickly changed after I realized I didn't actually like biochem all that much. Imagine what that would have looked like had I been attending a medical school instead of a "normal" college.
It sounds like what you actually want is an NP or something like that. Which is fine, there are plenty of those around.
What? Why should I care whether or not they went to college? I want them to be able to do their job, and I don't care about prestige whoring over competency.
Maybe if they hadn't required classes that are irrelevant to 95% of doctors (orgo, biochem and pchem), you would have been able to pursue the career you wanted. This is yet more support for the idea my friend who "I should never ever listen to" said about requiring far too much credentialing.
NPs would be fine... if they were allowed to give medical advise. Unfortunately, we still have to pay for someone with 6 years of excess schooling to come in to weigh in officially and to pay a huge premium for it.
Taking this discussion at face value, it sounds like US physicians go through substantially more training than their UK counterparts. If true, does that manifest itself in substantially better outcomes for their patients?
