Standardization is Nirvana to many, particularly regulators and payors. But, there are unintended consequences, one of which is called de-skilling. De-skilling is a process driven by a need to extract maximum value from labor. It occurs primarily by separating planning from execution and using technology to create efficient workflows.
In a paper titled, "De-skilling and adaptation among primary care physicians using two work innovations" Timothy Hoff, PhD, thoroughly analyzes primary care physician behaviors as they adapt to clinical guidelines, pay for performance, and EMR/EHRs.
There are at least 3 unexpected consequences:
- Less patient-specific information from specialists
- Visits become "checklist visits"
- Record completion dominates "over all else"
The implications of these unexpected consequences are huge. Providers talk to their laptops. Drugs are administered at the bedside with a scan of the wrist bracelet and without an explanation. Conversations are thrwarted. Medical providers at all levels have both implicit and explicit, ethical and moral, commitments to put the patient first. That the patient should always come first is undeniable, but what is one to do?
We incessantly seek an answer. We are not naive enough to suppose that all of this de-skilling will go away. We do know a couple of things that help:
- Slow down to speed up. Collaborate with your colleagues and supervisors.
- Find other ways to collaborate and coordinate care.
- Don't even try telephone tag and tardy written report.
- Collaborate: provide better care and enjoy satisfaction and peace.
We thank Kevin Pho, MD and Stephan Wilkens, MPH for bringing this to our attention.