She says the PRHI has been working on payment reform for more than a decade.
People are paid for volume. But if infections, falls or leaving sponges or surgical equipment inside patients are reduced, it requires additional work.
“Although we have been successful the last 10 years in putting in light penalties for these events, I think sadly enough, people have learned to work around them by how they code and report error,” Feinstein says.
Also, once health care providers reach the middle of quality rankings, she says reducing the volume further to become the quality leader isn’t worth it. The exception is Kaiser Permanente, which follows a different payment system.
In every other industry but health care, quality improvements are accepted, Feinstein says. While many factors are at fault, the payment system is a big obstacle.
To change attitudes, the PRHI has tried a little bit of everything, such as graduate fellowships and teaching young professionals.
Most recently, it is taking a systematic approach. The organization has trained about 900 people, setting up a health activist network to keep them linked and working toward reform. The PRHI also created a group for women leaders called WHAMGlobal.
Some of PRHI’s coaching includes attempting to teach health care workers about Lean quality improvement techniques.
“At the hospital level, they don’t have a clue how to use Lean,” Feinstein says. “They think it’s a Band-Aid — literally, an elixir. You’ve got a sore throat; take a dose of Lean.”
In a health care system, they might hire someone to be the Lean person, but that doesn’t mean the C-suite has done anything different, she says. They don’t wake up and think, “How can we make sure absolutely nothing goes wrong today? How can we make sure every director and manager is aligned?” They just do a little training here and there.
“It’s not something you do when something goes wrong. Lean is how you get up in the morning and do your work, how you orient your staff, how you choose your managers — it’s a way of life,” Feinstein says.
The PRHI also recognizes champions in the different health care sectors, including giving awards to people with sustainable quality improvement projects.
“We’re trying to create, I joke, an army of the revolution of people who want to be quality leaders, who really believe that health care could be safer, more effective, more efficient and get better outcomes at lower costs,” Feinstein says.
The PRHI uses the expression, “eyes that can see.”
“Once you can see the dysfunction, and once you can see better ways of doing things, it’s pretty hard to keep doing the wrong thing and causing damage and harm to people,” she says.