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Looking to Provide Quality Healthcare? Attention to (Seemingly) Insignificant Details is Key


Poor quality healthcare results from mistakes, such as mistaking healthcare for a commodity.

Unlike sugar, gold, and other commodities, the units in healthcare are not equivalent. Healthcare systems may be labeled similarly, and share certain characteristics, and still be significantly different.

The same can be said for healthcare providers and procedures—similar in some ways, but very different. And as many healthcare purchasers are realizing, the difference matters—to quality, to outcomes, and to cost. Employers who fail to recognize the difference are prone to poor healthcare purchasing decisions.

Recently, Curally spent time talking quality and the cost of poor healthcare purchasing decisions with Paul Summerside, MD, healthcare quality expert, Chief Medical Officer of clinical staffing provider Aya Healthcare, consultant, entrepreneur, and former healthcare clinic and hospital executive. 

In our podcast, Dr. Summerside calls out one of the biggest problems in managing quality and cost: a mistaken focus on unit cost. He then shares a few recommendations employers can follow to improve quality, cost and employee productivity.

The Problem with Focusing on Unit Cost

Poor quality has a cost, realized in:

  • Care complications and resulting additional procedures and other units of care.
  • Readmission to the hospital.
  • Tests that need to be redone.
  • Care complications.
  • Patient complaints, and possibly legal action.
  • Poor employee productivity, or loss of the employee.
  • Other consequential effects of poor quality care; it all has a cost.

Employers and other purchasers may not be considering these things. Thinking all providers are equal, all facilities are equal, etc., leaves purchasers to make provider decisions focused on unit cost and the discounts off the unit cost they can get. This focus is problematic.

A discounted unit cost may imply lower total cost for the employer or health plan, but the actual cost to the purchaser may be higher. Conversely, a high-quality provider may charge higher-than-average unit costs but, in the end, the cost for the entire episode of care may be lower.

Dr. Summerside recommends that employers look beyond the unit cost data for a given provider panel and learn how to evaluate the panel’s quality and performance. This is not as simple as it sounds. It may require the assistance of someone who understands the details that matter and can help navigate the complexities of healthcare. And healthcare is complicated!

Dr. Summerside explains that poor quality can be found in the details. Adapting to healthcare a provocative thought from Robert M. Pirsig’s Zen and the Art of Motorcycle Maintenance, Summerside says attention to tiny, insignificant details can result in big, significant returns in healthcare.

For example, cheaper blankets in a hospital may seem like a cost-effective choice, except when the cheaper blanket doesn’t do the job and the patient needs a second or third blanket to stay warm and more nurse time to get the additional blankets. The consequences of a poorly performing phlebotomist may include blown veins, delays in patient care and potentially complications requiring additional care.

To Lower the Total Cost of Healthcare, Address the Big Problem

While engaging quality providers is critically important, Dr. Summerside believes it is not the only prerequisite for truly reducing an employer’s healthcare costs. Employers must also work to address the single biggest health problem in most employee populations in the United States: sedentariness, lack of physical activity and obesity. It is pervasive.

Once they realize they have a big obesity problem among their employees, employers must be honest about it and recognize they need to make changes, said Dr. Summerside. One of the biggest returns on investment employers can make is creating or changing the culture in their company to encourage optimal body composition and activity levels. He admits that this is not a simple thing to do, but it is highly effective when it can be accomplished.

Changing behavior in an employee requires a relationship with an effective provider over a long period of time. By “provider,” Dr. Summerside means engaging various caregivers, including condition managers, doctors, nurses, health navigators, and trainers who can be change agents for the employee. They will need to work extensively with the patient, pulling the “million strings that have to be pulled to change lifestyle.”

Find a Good Partner to Help Make a Change

Ultimately, with appropriate understanding and attentiveness to what matters in providing quality, lower cost healthcare—the “insignificant” details that add up to significant results—employers can make big improvements in their health benefit plans. But employers cannot do it alone. Even the things that appear to be simple in healthcare are complicated.

Employers need a partner, a change agent, who understands what matters and pays attention to the details. Curally is a proven change agent and partner to employers and their patients needing that additional, even intensive attention.