Is Competition Bad?
There’s an old joke I like in which two hikers discover a bear in the woods. The bear spots them and starts running at them full tilt. One of the hikers immediately drops his backpack, pulls out a pair of sneakers, and starts removing his boots. “What are you doing?” asks the second hiker. “You’ll never outrun a bear!” The first hiker says, “I don’t have to. I just have to outrun you.”
Public reporting of hospital patient safety measures is a big bear.
Anyone can go to the Hospital Compare web site to rank hospitals in their region. If I enter “04401” for a location, for example, I see hospitals within 100 miles of Bangor. If I select three hospitals to compare, I’m taken to a page that lists scores for specific measures, including patient satisfaction.
But I can also learn, for instance, about “Hospital Acquired Conditions” such as objects left in the body after surgery, bed sores, and urinary catheter infections. This can be eye-opening for both patients and healthcare workers.
A limited amount of resources competing for patient dollars is great, if it means greater access to quality services, but any one place is unlikely to please or cure all patients. Exclusion tends to decrease choice, and quality reporting reflects random as well as systemic incidence.
Closer to home is what may be happening inside hospitals. As reimbursement dollars are squeezed under the pressure of public reporting, I wonder how often departments are pitted against each other to move customer- and quality-based scores or how often departments are ignored for the sake of the few that can most impact those scores.
If all departments in a hospital are required to discuss a topic during meetings and this information is reported to a committee, does that create competition? What if the manager is forced to grade employees on measures? What if merit raises are tied to this performance? Competition is the dark side of public reporting.
The hiker with the sneakers loves competition. His buddy has a different opinion but not for long. The bear stays the same.
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