Too Much Stupid Stuff

Melinda Ashton, M.D., has a great article in NEJM: Getting Rid of Stupid Stuff.   It describes a program her health system (Hawaii Pacific Health) undertook to do exactly that, with some promising results. 

That sounds like something everything in healthcare should put at the top of their priority list. 

The impetus of their program was to address the issue of burnout, specifically around documentation burdens.  Their EHR had been in place for 10 years, and they reasoned that some tasks might no longer be necessary or appropriate.  So, starting October 2017, they asked all employees to nominate anything in their EHR that was "poorly designed, unnecessary, or just plain stupid."

If that sounds unusually blunt, credit Dr. Ashton.  She explained to FierceHealthcare:  

We were going to call it ‘administrative simplification’ for a while and I sort of pushed back and said, 'You know, I really think we need to be clear on this.'  I just had a sense that calling it stupid stuff was going to resonate better.  

Dr. Ashton and her team reminded employees that: "Stupid is in the eye of the beholder. Everything that we might now call stupid was thought to be a good idea at some point.”  Fair enough.  They expected nominations to be in three categories:

• unintended documentation that could easily be eliminated;
• documentation that was needed but that could be collected more efficiently;
• documentation that needed better training to accomplish.

They ended up getting nominations in all three categories, and have already implemented a number of changes, as well as eliminating 10 of the most frequent 12 physicians alerts, because they were just being ignored.  Interesting to them, but not surprising to me, they got more nominations from nurses than from physicians.  

Credit: NEJM, Melinda Ashton MD

The program has now been extended beyond just documentation and beyond just the EHR because, as Dr. Ashton writes: "It appears that there is stupid stuff all around us."

Boy, put that one on our healthcare system's tombstone.  

It would be easy but short-sighted to take healthcare's collective frustration out on EHRs.  Many clinicians feel like EHRs were forced upon them, not designed for their ease, and ended up taking time and attention from actual patient care.  Nor have their fulfilled their promise of making patient records easily accessible across providers, improving care by more quickly identifying previous issues and reducing duplicate treatments.  

But let's not kid ourselves: EHRs are not the stupidest thing we have in healthcare.  EHRs may, in fact, be the smartest stupid thing healthcare has done, because at least there are significant upsides to having EHRs, even if we're not achieving them yet.  There are plenty of things we do in healthcare that are just plain stupid.

Admit it: if you work in healthcare, you see stupid stuff every day.  Some are things imposed on you from external sources, and some are things required by your own organization.  

As Dr. Ashton cautioned, some may have been a good idea at some point.  Some may never have been a good idea.  Some are things that just keep getting done simply because of habit/ tradition/rules.  Some are stupid things that someone, somewhere, still thinks is a good idea but, when push comes to shoving patient care, aren't. 

They're still stupid, and should be stopped. 

Maybe your healthcare organization has a process for taking suggestions (from employees and/or patients), but I'd question how often that results in changes that ease some of the worst pain points.  I love what Dr. Ashton and the team at Hawaii Pacific Health are doing, and think every healthcare organization undertake a similar effort to stop doing stupid stuff.  

That hard part won't be finding the stupid stuff: the hard parts are getting people to speak up about them, and making the changes needed to actually get rid of them.  Many stupid things are inter-organizational rather than intra-organizational, which makes it harder -- but not impossible -- to change them.  

A few months ago I wrote that healthcare should learn from Dan Gingiss and "do simple better," because "in healthcare we make the simple complicated, we make fast slow, and we make fun at best boring and worst scary."  I urged that we should strive to make healthcare simple, or at least simpler.  I still believe that, but now I think that before we do even that we should work to make it less stupid.  

We'll probably find that doing the one will help accomplish the other.

The program at Hawaii Pacific Health as aimed primarily at reducing daily frustrations for its employees, but we need to go much further.  These kinds of programs need to attack daily frustrations for all stakeholders, and especially for patients.  

If you are a healthcare leader, start a program like this.  If you work in a healthcare organization, advocate for one until your leadership puts one in.  If you are a patient or family member of one, don't wait for a formal program from the healthcare organizations you interact with; speak up about the stupid stuff you see and have to deal with, and make sure your thoughts get to those organizations' leadership.   

It's stupid to accept stupid stuff, especially with something as valuable as our health at stake.

In the meantime, if you want to report stupid stuff in healthcare, put it on the comments below, or on one of the threads about this article on Twitter, or on posts about it on Linkedin and/or Facebook.  It probably won't get it fixed, not right away, but we can at least get more of the stupid stuff out in the open.