Today's industry faces change? Same as it ever was
By Leslie C. Norins, MD, PhD
President
Global Success Corp.
Naples, FL
[Editor's note: Leslie Norins started Hospital Peer Review (HPR) 20 years ago. He is now president of Global Success Corp., a publishing company in Naples, FL. Norins looks back to the reasons he began HPR and finds many similarities to today's health care scene.]
When we launched Hospital Peer Review in 1976, many people wondered what we would write about after the first few issues. They thought we would run out of topics, and the newsletter wouldn't be needed after a year or two. However, growing economic and regulatory pressures provided a wealth of issues to hold our attention.
Sound familiar? It should. As I look at today's health care landscape and the roles quality managers are asked to play in it, I see striking similarities. We face forces and conflicts similar to those we saw 20 years ago.
There was a lot of confusion back then. Shortly after we launched our first newsletter, Hospital Infection Control (HIC), in 1974, we started receiving letters from its readers. Infection control nurses in smaller hospitals increasingly had to wear two hats, that of infection control and peer review or quality assurance coordinator. They asked: "We like what you have in HIC. Could you do the same thing for peer review?" We thought we could and gave it a try.
First, we had to learn all the terminology and who the players were in quality assurance. We knew bacteria, not quality assurance lingo. What we found out was that there were a lot of scholarly journals that were thick, full of regulatory legalese, and hard to read. People wanted fundamental information written in friendly, down-to-earth language. Hospital Peer Review was really thought up by the grass-roots practitioners. I think it is fitting on its 20th anniversary to tip our hats to them.
In the early days, more and more people were recruited by hospital administrators to figure out how to comply with peer review and the then Joint Commission on Accreditation of Hospital Organizations requirements. There was a great need for elementary information for newcomers to the field. I suspect that still today there are people in search of such articles. But since quality assurance and peer review have been on center stage for so long, today's cadre of trained people is much larger than it was back at our beginning. More sophisticated information is needed for them. As long as I can remember, HPR has had to serve many levels of experience in its audience.
We realized after the first few years that we had two distinct groups of readers -- utilization reviewers and quality assurance people. Utilization review looked at hospital lengths of stay and quality assurance people conducted audits. They often did not even talk to each other. Only in a very few hospitals were they put together. We decided at the beginning that HPR's pages would have about 50% utilization review stories and 50% auditing stories.
With utilization review, there was a lot of controversy about government intrusion and second-guessing physicians on length of stay. With quality assurance, the big issue was the Joint Commission. I knew whenever we could run a front-page story about a Joint Commission regulation, that issue's readership boomed.
One of our finest moments early on was the time the Joint Commission announced a new quality assurance standard that required hospitals to establish a list of unsolved problem areas. To have such lists in existence seemed to us dangerous from a liability standpoint. This issue seemed worthy of a journalistic full-court press. We called the top legal counsels and organizations around the country and discovered that such a list was legally risky. Also, it appeared the Joint Commission had not checked out the idea first with any of these people.
We respectfully wrote the head of the Joint Commission and told him what we had found. We were afraid they would blacklist us, but they took it in good stride. Our article received wide attention. Within two or three years, the standard was rescinded or superseded by other standards.
In the beginning, many hospitals had one lone utilization review person or quality assurance professional. Those lone workers didn't have any way to calibrate themselves against others or exchange tactics with their colleagues. Our newsletter served as a clearinghouse on nitty-gritty issues. People could see they were not alone and their problems no different than their peers across the country. More than 240 editions later, readers still seem to want this kind of information. We were very fortunate to catch this wave to glory. *
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