We are pleased to bring you this article by Devin Cabanilla, who is a Lean practitioner in Healthcare, working at a large hospital system in Washington State. Devin’s previous article on shmula is his 7 Wastes of Medical Billing.
His article highlights an observation regarding standards and room for error, as it pertains to medical documentation and medical coding. What he uncovers is an interesting commentary on basic human behavior – do strict guidelines that are designed to save lives not in alignment with the basic human behavior to cut corners?
His advice and answer?
Don’t Give Out Fudge.
Enjoy this article and learn more about Devin Cabanilla in his author bio at the end.
The opportunity to talk about healthcare and standards doesn't present itself frequently in public. I was in attendance at a nice wedding recently out in the countryside. My wife and I found ourselves at a round table with strangers in a converted barn. The older couple closest to my wife and I were very friendly and warm. We counted ourselves lucky.
We made our introductions, talked about how we knew the couple, and had chocolates together. As the event continued the older gentleman leans over to me and asks,
"Your wife says you do computer work at a hospital?"
Sometimes I'm in the mood to talk about work at these events, and other times I'd rather just enjoy the event. I relent and mention the obscure topic of Electronic Medical Records (EMR/EHR). So, I let him know that healthcare organizations everywhere are getting into EMR/EHR upgrades right now because by next year all medical diagnosis coding will need to be converted into newer standard called ICD-10. Pretty boring, we can move on to talk about something else. All of a sudden our good wedding company went into dispute mode.
My fellow wedding guest starts to get into this sound off with me how this is likely
"…another move to a Nanny State,"
And begins to politicize the topic. I'm not making a point for government or anyone in our conversation. I try to put the pause button on right away because I'm thinking to myself:
- Standards are necessary
- Patient Safety is essential
- Transparency is a benefit
I sidetrack a little bit and explain it's important for doctors to be accurate in their notes for the benefit of patients. I let him know several things. You wouldn't want to have a generic diagnosis listed of just plain cancer. Hopefully, your doctor is noting explicitly you have a malignant neoplasm of the pancreas with the corresponding diagnosis code. It would be unsafe if you were referred to another doctor and the documentation of your condition was poor.
Additionally, having accurate information allows for the patient and all those involved knowing exactly what's going on. The newer ICD-10 coding gives more diagnosis and problems that weren't available before. Suddenly I'm wondering when I became an apologist for ICD-10?
Strangely, his response becomes,
"Well you gotta give doctors a little room to fudge!"
It becomes apparent to me that in general, people are concerned when levels of control are too strict. Having a little deviation is acceptable. To err is human, right? We can't totally alleviate the tension that politics has put on operational improvements in healthcare. Yet, there is a responsibility for those in healthcare to be better.
We have to save lives, not give out fudge. Whether this is in software records, or how doctors treat others, the bar should be set high. Even good fudge has its taste because of a recipe and quality ingredients.
About Devin Cabanilla
Devin Cabanilla conducts continuous improvement activities in insurance enrollment and billing database areas at Virginia Mason Medical Center in Seattle.
He applies the principles of Lean Management (also known as Lean Manufacturing) to his work in healthcare. Outside of work Devin enjoys BBQ, Starcraft, reading, and spending time with his wife and two toddlers.
Table Conversations: Fudging Healthcare is a post from: Lean Six Sigma Consulting
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