Learning how to cover up superbugs?

The Shropshire Star has reported (“American experts to lead improvements at Shropshire hospitals”) that the NHS is bringing in so-called experts from Virginia Mason Hospital in Seattle in a bid to improve care at the two local hospitals.

They don’t report that this is costing the NHS $13 million (over £8 million) at a time when the local NHS is strapped for cash. So what are we going to get for our money?

Probably a lesson in how to cover up damaging problems. The experts come from the same Virginia Mason where 11 patients died as a result of a superbug infection. The outbreak ran from November 2012 to March 2014. Virginia Mason officials have admitted that they declined to inform patients or the public – and the superbug outbreak only became known at an infectious disease conference in October last year. According to a news report: “None of the patients nor their families was notified that they were part of an outbreak, hospital and health officials said.”

Perhaps the reason the hospital were so reluctant to let the public know is that they are in competition with other hospitals in their area. They wouldn’t want their potential customers (and they call them “customers” not “patients”) to be put off.

On their website they have a set of questions and answers on their billing and charging policies. Most revealing is how they work out the charge for services:

“How is a charge set for my services?

“Market competitiveness: competitor prices and availability of services in the marketplace.”

So they will charge you as much as they can if they can get away with it – if no one else can provide a particular service at the time you need it.

We are not talking about small amounts of money. The hospital publishes an estimated price list for what it describes as Minor Procedures. Cataract surgery can cost up to $8,627 (over £5,500); even cleaning wax out of your ears will cost you $346 (over £220) – both procedures are free on the NHS. For all procedures at Virginia Mason, you have to prove you can pay for them upfront, when you arrive at the hospital – or they may agree to enter into a legally enforceable payment plan if you are too poor to pay all at once.

So apart from covering up superbugs and lessons for the future in how to charge patients, what else can we expect from these “experts”.

They have sold to the NHS something called the “Virginia Mason Production System (VPMS)”. This the way they claim they have made their own hospital more efficient.

They claim a number of successes. One of them is that “this work helped Virginia Mason decrease the number of hours the ED [Emergency Department] was closed and unable to receive new patients.” So that they define success in reducing the time their A&E is closed. We may have problems at Royal Shrewsbury and Princess Royal, but it hasn’t got that bad yet.

This VPMS is based on the same system Toyota uses to make cars – that’s where the “Production” comes from in the name. So how can a process used to manufacture cars be applied to healthcare? Virginia Mason answer: “Toyota and Virginia Mason share the same core values: quality, safety, a relentless focus on the customer…” The claim is that this system will “continually improve how work is done so that the final product has zero defects.”

Toyota has been using this system for decades. This week, on July 15, they announced they were recalling 625,000 hybrid cars because of a software glitch. In June they announced “Toyota will now globally expand its recalls to involve approximately 2,860,000 additional vehicles equipped with certain front passenger airbag inflators.”

So much for “zero defects”. But the problem for healthcare is that you can’t just recall a patient when they’ve been given the wrong treatment or infected by a superbug.

For all the talk about “zero defects”, and concern for the “customer”, the prime driver behind the process Virginia Mason are selling is cost cutting and staff reduction. They boast “we reduced labor expense in overtime and temporary labor by $500,000 in just one year.” That’s why the CEO of Virginia Mason has been paid over £2 million in salary.

That is not what we need for Royal Shrewsbury and Princess Royal. All the talk about efficiency savings is really a cover for cuts that endanger patient welfare. We know that clinical safety is dependent on having more nurses and more doctors. That’s what our health bosses in Shropshire should be looking at. The NHS needs more money to provide adequate staffing not more efficient ways to cut services.

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