Arrowsight Medical: Healthcare Quality Meets Big Brother
Preventing avoidable medical errors -- which most likely still account for close to 100,000 deaths a year in U.S. hospitals -- remains one of the most important quality-control efforts underway in healthcare. It's a huge challenge, though, largely because most errors result from the actions and inattention of thousands of loosely coordinated doctors, nurses and hospital staffers.
Now one of the pioneers in measuring hospital quality (itself a much fuzzier concept than you'd think) is launching a new and rather Orwellian approach to ensuring that those disparate actors follow the accident-prevention guidelines they're supposed to follow. Suzanne Delbanco, who founded the quality-promotion coalition Leapfrog Group almost eight years ago, left recently to head up Arrowsight Medical, a new venture that aims to look over the shoulders of doctors and nurses -- literally.
Arrowsight Medical, a new arm of the remote-viewing IT developer Arrowsight, intends to focus on "hospital video auditing," which involves the remote oversight of safety procedures such as hand-washing and sterilization of equipment and devices. According to an interview with Delbanco at the WSJ Health Blog, the intent of such surveillance is simply to monitor compliance and to provide feedback intended to improve it.
"There are lots of things that can only be measured visually that we hope to be able to use this methodology for," Delbanco said. The company says the video is purged routinely to protect the privacy of everyone involved, and argues that it won't be used to punish individuals, just to motivate medical professionals to follow the rules.
As with most new approaches in healthcare, advocates -- in this case, all associated with Arrowsight -- are already making some big claims for video auditing. Supposedly an early pilot project at an unnamed walk-in surgical center with 20 employees was successful at boosting adherence to hand-washing protocol above 90 percent from just 35 percent and maintaining it for 12 months.
Sounds promising, I suppose, but there's an equally good argument that the hospital-quality movement has led to such a proliferation of new rules and guidelines that they're almost difficult for your average healthcare worker to follow. Using high-tech surveillance to monitor and force compliance with guidelines that are already too complex for most people could easily lead to situations where whatever's being monitored gets special attention while everything else suffers. Robert Weinmann, a physician critic of the system, argues that it will encourage "working-to-rule" -- doing exactly what's expected and nothing more.
By contrast, Johns Hopkins physician Peter Provonost recently won one of the MacArthur Foundation's "genius grants" for his own pioneering work in condensing dense sets of ICU safety protocols into just five precautionary steps. Tests in Michigan hospitals suggested that the changes not only substantially decreased the rate of infection in intensive-care facilities, they did so by fostering a cultural change among physicians an nurses that elevated the importance of preventing hospital-acquired infections.
Now, "cultural change" is one of those fuzzy phrases for a shift in attitudes and practice that can be difficult, if not impossible, to measure, and as such it's never as popular with the stopwatch efficiency-expert crowd as the latest high-tech innovation. On the other hand, if what you're really interested in are improvements in medical outcomes -- that is, changes that keep people healthier, shorten their hospital stays and keep costs lower -- it probably makes a lot more sense to focus medical professionals on those outcomes and not on blind rule-following.
Unfortunately, healthcare is every bit as eager for quick fixes as any other industry. If Arrowsight Medical is successful -- and I don't see much standing in its way -- it'll be the latest sign that the ghost of Frederick Winslow Taylor continues to haunt the C-suites of hospitals across the country.
Image via Flickr user elliottcable, CC 2.0
