The healthcare system overhaul will take significant time and energy, but creating a more accessible and sustainable healthcare system is the ultimate goal.
Bruce Ramshaw, MD, founded Surgical Momentum in 2009 to improve patient safety and the quality of care. The company provides real-time clinical insight into quality improvement programs, patient care value improvement, device assessment and consulting services, ultimately leading to efficiency and cost reduction.
"I wanted to look at what solutions we need to develop and transition the healthcare system from one that is fragmented to one that has value to the patient and is more sustainable," says Dr. Ramshaw. "Surgical Momentum is a mechanism to implement the structural change. The implementation isn't always easy, as you can imagine, the healthcare system is entrenched in the status quo."
Here are a few key steps to improving the healthcare system and making it more sustainable:
1. Identify the problem and process. "If you can't define the process, you can't define the value," said Dr. Ramshaw. "Figure out what outcomes define value, patient satisfaction, participation and the actual cost of care."
2. Find the cost. "If you can't manage the actual cost of care, you can't define and improve the value," says Dr. Ramshaw. "We started the pilot program with hernia surgery and worked intentionally with the industry because part of the patient process is improving drugs and medical devices. We measured the value of their treatments so we could understand what made the most positive impact and what caused harm."
3. Figure out why harm was done. "There is a lot of medical error and bad outcomes related to drugs," says Dr. Ramshaw. "We don't currently have a system in place to understand why. There are screenings and tests, but one of the common misunderstandings in healthcare is that recommendations and guidelines will fix all issues. However, patients are different and come from different populations, so we are seeing a failure of the one-size-fits-all approach now."
4. Use predictive data analytics to develop a care plan with the patient. Data can help healthcare providers understand how individual patients will respond to treatment based on how similar patients responded in the past. Data can help identify at-risk patients to prevent issues. For example, most women have breast cancer screening, but not all women are diagnosed with breast cancer.
"With the current understanding of data, we don't know which women aren't helped by mammograms," says Dr. Ramshaw. "The starting point is to engage women and help them through the shared decision-making process. We can then use predictive analytics to better define the context of care."
But that doesn't necessarily mean everything is completely customized. "We're headed in the future to show predictive algorithms, but there is a misunderstanding that personal medicine will cater everything to the patient," says Dr. Ramshaw. "That's an incomplete understanding of reality. We're constantly updating and changing with new information about different genomes. You can't take a genetic view of a person in one moment and expect that to be the same next year."
5. Involve patients in the decision making process. "It starts with just engaging the patient and family in the decision-making process instead of just the surgeon," says Dr. Ramshaw. "We don't always know what is right for each individual patient. We can collect data and help the patients make better decisions based on their individual situations."
For more than five years, Dr. Ramshaw and his colleagues have had a patient and family committee advise on how they can improve patient care. "One of the committee members asked why we don't show the mesh we use during surgery to the patient beforehand," he says. "Now we have a book of meshes and any patient who wants to look in can. Some want to feel it, others ask questions about which one is better. They want to understand what is being done to them."
6. Sharing is important for evolving the healthcare system. "We can give presentations on peer review articles, but there are also other ways for doctors to connect through social media," says Dr. Ramshaw. "And you can bring together multiple local sites to collaborate on collecting data. Local sites have different variables, so they have to adapt their own improvement ideas. We can share those ideas and come up with process improvements."