The outcomes experienced by consumers of healthcare result from decisions made by many people. (Medicine is a team sport.) After an adverse impact (injury, additional treatment required, death, delayed recovery), there is feedback to those recognized as responsible, i.e., doctors, nurses, allied health personnel, while others, who also impact the quality of care provided, are not considered responsible. For them, there is no feedback. This is a double standard. The purpose of feedback is to promote a desired outcome. When the system achieves the chosen result, feedback encourages the status quo. When the outcome is adverse, feedback tries to restore the non-adverse condition. In the practice of medicine, the legal tort system is the primary feedback mechanism, intended to deter the actor and to compensate the victim. It has little impact on improving future outcomes and as such, is inefficient. For healthcare management and regulation, there is no feedback system. When a patient waits 8 hours in the ER, or there is no translator available, or there is a communication error because of HIPAA, there is no feedback to or consequence for managers who make budget choices or legislators who pass regulations. Therefore, there is neither deterrence, nor compensation, nor quality improvement. We do NOT recommend extension of the current punitive system to managers and regulators. A new incentive system should be developed that encourages risk-taking and rewards positive outcomes for patients. Since all results derive from interactions among people, application of systems thinking would be helpful.
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