Dave,
I certainly agree that merit pay has merit, as do the other examples
that you mention to align tangible commitment and "points."
On the other hand, the Health Indicators data is needed to provide some
evidence that a new input – e.g., a merit or pay for results pay plan – produces a net upward delta – e.g., improved healthiness outputs or some other payoff – e.g. improved staff retention, presuming that in turn staff retention generates better health indicator feedback.
At the policy level, it becomes hard to select among the myriad of good
initiatives (and hardly anyone advances an initiative that is wholly without merit). It is also hard to propagate best practice, unless there is pretty substantive data to persuade others to follow suit and to guide them in shaping their own implementations.
Fulton Wilcox
Colts Neck Solutions LLC
From: David RR Webber (XML) [mailto:david@drrw.info]
Sent: Tuesday, March 06, 2007 5:54 PM
To: fulton.wilcox@coltsnecksolutions.com
Cc: ihc@lists.oasis-open.org
Subject: RE: [ihc] Throwing more money at the problem?
I would add to this - the need to have health performance indicators
that reward good behaviour by staff beyond simply financial goals.
Examples - why work smarter and better - when nurses are paid by the
shift regardless of how many or how complex the patients are they treat? Fewer is better in the current reward matrix. Not only that but fewer patients less risk of malpractice, less irrate family members, less effort.
What about bonuses tied to good practices or diagnosis that make a
significant contribution to a patients recovery / treatment? How about "points" that can be traded for priorities on unit scheduling and other intangibles - that hard-working staff end up at the back of the queue for compared to other's who invest most effort in social networking? Points can be garnered in variety of ways - such as volunteering to complete unit plans, care plans, and so on.
Then we also need to factor in performance bonuses around better
practices management.
The one that sticks in my mind is when the bean counters for the UK NHS
determined they could save $M by removing patient daily orange juice cartons. The next result was a cost escalation compared to the orange juice. Why? Because the nursing staff were recycling the empty juice cartons for bio-waste disposal. Now they had to order custom bio-hazard cartons at triple the cost of the orange juice ones!
But management should be favoured on staff retention, staff satisfaction
and unit morale - right now - none of that applies - again managers attach much more effort to budget balancing, back-covering meetings / procedures and social networking than addressing unit issues that can lead to dramatically happier less stressed staff and hence better patient care.
DW
"The way to be is to do" - Confucius (551-472 B.C.)
-------- Original Message --------
Subject: RE: [ihc] Throwing more money at the problem?
From: Fulton Wilcox <fulton.wilcox@coltsnecksolutions.com>
Date: Tue, March 06, 2007 5:28 pm
To: "'David RR Webber (XML)'" <david@drrw.info>,
ihc@lists.oasis-open.org
Thanks for the referral to the New York Times article. My concern
has been that we cannot distinguish between money "thrown away" versus money well spent, because of underinvestment in performance data. Hence my interest in "Health Indicators."
It also seems true that the current flurry of "perfect storm"
predictions concerning U.S.
healthcare funding are unduly influenced by "payer" perspectives,
obviously distinct from provider perspectives and, as described in the New York Times, from people's willingness to pay. Unfortunately, health-related data is too coarse and incomplete to validate payoff and cause and effect, so we end up with a rather confused dialog about efficacy versus waste.
Although there are warnings that healthcare and eldercare will "break
the bank" by 2017, I was rather startled by the Congressional Budget Office's rather benign projections of U.S. conditions in 2017, especially that Federal Government's external debt will be declining from today's 37% of GDP to 20.1% of GDP in 2017. The bank apparently will hold up quite nicely.
Not to disappoint you, but I don't see us working "smarter" – that
aspect of evolution seems to have stopped, but we should work better informed. See the attachment on this subject – my apologies for its length.
From: David RR Webber (XML) [mailto:david@drrw.info]
Sent: Friday, March 02, 2007 11:34 AM
To: ihc@lists.oasis-open.org
Subject: [ihc] Throwing more money at the problem?
Most Support U.S. Guarantee of Health Care
By ROBIN TONER and JANET ELDER
Americans are willing to pay higher taxes to guarantee that
everyone has health insurance, according to a poll.
http://www.nytimes.com/2007/03/02/washington/02poll.html?th&emc=th
The sad thing is - as per discussions yesterday - this is exactly NOT
the answer.
We need to be much smarter about the use of resources and funds then
today.
Obviously a huge amount of money is wasted in fruitless admin' paperwork
- just for starters.
Then - providing metrics to allow people to self-correct dangerous
health maintenance behaviours.
And improving the level and quality of care within the system.
"The way to be is to do" - Confucius (551-472 B.C.)