Issues and Problem Determination

Issues which consistently come up in Health Care projects are:

Funded projects are still today driven by donor or special interest organizations instead of the demand from clients. This makes these projects very different from projects where demands are created by the consumer for general health care services. Services must be sold just as any other business product. This requires marketing research. Today there is insufficient data collected and of the incorrect type to provide that type of research.
They is no cooperation or coordination between the many different agencies performing the same type of services. Consumers are confused and overcome with information which they cannot assimilate. Information is duplicated, lost, and simply not used properly. There is a tremendous waste of resources.
Because most projects are "Project Driven" the local staff have little incentive for good performance. They have no job security because they may not have a job at the end of the project.
Training has done little good. The reason for this is that, even if a person is very well trained, he soon looses interest if he is neither monitored or given incentives. Because, in generally, measurement of management has been lacking, there has been no fair way to reward those who perform well. Because local management feel isolated and have little supervision from upper levels, they have no incentive to improve performance. "Out of sight, out of mind"
Problems occur from the addition of new objectives and variables to the original project. This usually occurs in Family Planning when MCH and EPI are included. The addition of variables to the present information systems is costly and usually require totally different personnel to monitor.
A manager cannot manage if he is not able to obtain all the information he needs as it occurs and in the detail that he needs it. Summary data once every six months is too late and not enough. If the data values are not within range, he has no way of knowing why. The hierarchical management system where data is summarized and pass up to the next level once a year, is useless for management purposes.
Most information systems today simply determines the rates of occurrence of events distributed by sex and age. Very few attempt to determine "why" these events occur or the relationship between these events. An example would be the determination that deaths have been declining. Unless we know "why" then this data has very little meaning.
Diagnosis Error

Note taking, Progress Notes, and Summary Notes

InHCc believes that notes presented in sentence form is time consuming to create and may be a patient safety problem.

A “Very brief narrative description” of the of a patient encounter is dangerous .

The chance that "Summary Notes" leaves out just that bit of information that another individual needs is too great to risk.

Notes in sentence form are used by HCP's for patient information. However, while the notes are written in sentences...HCP generally scan the document...they do not read every sentence or work. When this happens, data may be missed or "misread". An earlier, faster, and safer method is to record the data in a "Concept-Value" format. An example may be a list of vital signs, a list of symptoms or examination findings...

Age: 55

Gender: male

BP: 155/100

Heart rate: 95

Previous problems: hypertension, diabetic

etc....

We find this easier to do with the computer, it is faster to read, and fewer mistakes in the translation.

We believe that text written progress notes should be something of the past.

Examples

A complete patient history does not have to be rewritten. Past histories contained in the system can be reviewed and updated. This creates a more accuracy history in addition to being more efficient.

Surveys

What has been done (information collected from surveys) is NOT important other than to give an indication of how many are NOT doing the right thing! Surveys tell me more about the management of the organization or the ability of the individual to manage rather than telling me about what is right (best) or wrong.

The only thing that is important is what needs to be done for effective and efficient health care.

An individual’s response to a survey is based on the following (at least):

His education (where, by whom, when, how)
The existing customs where the HCP practices

In summary, surveys report what has been done…not what needs to be done.

Information should be relevant. If the data cannot be used, do not collect it.

Competition

While competition may have the best hospitals alive…it does not promulgate those best practices to others. The assumption is that everyone will compete in producing the “best solutions”…creates the environment where no one wants to share information…and what may happen is that one organization produces the “best practices” and runs all others out of business…thus creating a monopoly.

Commercialization

All branches of science are grappling with commercialization and its effects on discovery, academic discourse, and publication.

While there are many pros in commercialization of Healthcare, InHCc beliefs that the Government should control the funding of Healthcare. The payment for healthcare services, new devices and technology can still be based on performance.

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