In the dance of health care delivery, better management saves lives

A new study highlights the potential for improving procedure-related survival rates by understanding which health care delivery processes contribute to the best outcomes. The research sought to define the differences in care that might account for the wide variation in mortality rates currently seen among dialysis centers across the country. Researchers interviewed clinical staff at 90 dialysis centers and compared differences between facilities with the highest and lowest mortality rates.

A joint effort of the VA Greater Los Angeles Healthcare System, Amgen, and dialysis companies DaVita, DCI, Renal Ventures Management, and Satellite Healthcare, the findings identify 19 characteristics of dialysis care delivery that account for 30% of the variation in mortality among the highest and lowest performers. Characteristics associated with the highest survival rates, which were statistically significant after accounting for how sick patients were, basically boiled down to:

* Patients who were more engaged in their care

* Better communication and relationships among clinical staff

* Better care coordination and staff management

* Top-notch, innovative dietitians

Perhaps the only thing surprising about that research finding is how well it meshes with what your intuition might tell you: That health care improves with better management, better teams, and patients who are active members of their care team. The next step is to develop best-practice guidelines, and measure their effectiveness with randomized clinical trials. Not an easy series of steps, since the demons of change often lurk in the details of implementation.

The greatest potential for these findings may be that they likely apply to health care processes beyond dialysis. Further, they represent an important shift in health care research towards a look at the delicate and often complex multidisciplinary dance that is often involved in bringing care to a patient. In fact, it is the dance itself that constitutes care, not just the associated procedures or interventions. And like the Argentine Tango dancers pictured above, all participants must contribute to a harmonious effort. Coordinating that dance, and better understanding its steps is a crucial part of improving all processes and systems of care, with the ultimate goal of improved patient outcomes and population health.

Photo credit: Dance Photographer