I have come to understand that I, as a physician, may define the quality of hospitals in a different way than some non-physicians. For example, some of them will place emphasis on the friendliness of the staff, proximity of their home to a hospital, or the hospital physical plant. By way of contrast, I tend to focus more on the national reputation of the hospital, whether it's a training institution, and the quality of the staff physicians.
In my recent note about the quality issues that have cropped up in the VA hospitals, I compared the VA health system to the military hospital system (see: Why the Military and the VA Healthcare Systems Are Not Amenable to Change). With regard to the VA and the military, I suggested that part of the problem was the military culture based on chain-of-command, the diminution of individual responsibility and decision-making, and the need to "correct" records that were embarrassing. Just published is a brilliant investigational piece in the New York Times that takes the military health system to task for major lapses in the quality of care that it delivers (see: In Military Care, a Pattern of Errors but Not Scrutiny).
Here's an excerpt from the long NYT investigational piece:
More than 50,000 babies are born at military hospitals each year, and they are twice as likely to be injured during delivery as newborns nationwide, the most recent statistics show. And their mothers were more likely to hemorrhage after childbirth than mothers at civilian hospitals, according to a 2012 analysis conducted for the Pentagon.In surgery, half of the system’s 16 largest hospitals had higher than expected rates of complications over a recent 12-month period, the American College of Surgeons found last year. Four of the busiest hospitals have performed poorly on that metric year after year....
The Times’s examination, based on Pentagon studies, court records, analyses of thousands of pages of data, and interviews with current and former military health officials and workers, indicates that the military lags behind many civilian hospital systems in protecting patients from harm. The reasons, military doctors and nurses said, are rooted in a compartmentalized system of leadership, a culture of interservice secrecy and an overall failure to make patient safety a top priority.
I believe that, in the military and VA health systems, the military culture is so dominant that it trumps the healthcare safety and quality culture that is broadly accepted in the civilian sector. The military views its primary mission as preparing its personnel for medical support in the next shooting war. I understand this and believe that it's highly relevant. However, a very high price is being paid by the wives and children of active military personnel and veterans who suffer from inferior healthcare delivery.
The answer to this conundrum is simple. Simply allow active military personnel, their dependents, and veterans to seek health care in high quality civilian facilities if they wish to do so and without any restrictions. However and as I noted in my previous note (see: Why the Military and the VA Healthcare Systems Are Not Amenable to Change), it will be useless to merely throw more money at the VA and military health systems as an incentive for them to achieve "civilian" quality measures. It's a standard response of federal agencies to say that all they need is a bigger budget in order to achieve some goal. The resources to enable military personnel to seek healthcare outside the military and VA system should come directly from current military and VA budgets. Such a course of action would, of course, become a political football so probably won't happen.