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The Problem with Rules and Regulations . . . They Can Kill

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While this story is from a VA run acute care hospital it very aptly demonstrates how over burdening healthcare with rules and regulations hurts the people it is supposed to serve.

The Story

A Veteran in the cafeteria of the Albuquerque Veteran Affairs hospital collapsed. The cafeteria was about a 500 yards (a five minute walk) from the emergency room.   The hospital protocol for someone who collapses in the dining room is to call an ambulance for transport to the emergency room.   They followed the protocol to the T. It took 15-20 minutes for the ambulance to arrive. It was around 30 minutes from the collapse until he was in the emergency room.

He Died

Additional Data/Questions

There were medical personnel in the dining room who performed CPR until the ambulance arrived, but 30 minutes is a long time for CPR. Assuming he had a heart attack, the reality is that most people who have heart attacks die and so maybe doing something different would not have made any difference . . . but maybe it would have. It is baffling that no one in the entire cafeteria thought it was a good idea to locate a gurney and roll that veteran by hand to the emergency room. There, a full suite of cardiac equipment and drugs that might have saved this man’s life.

  • Why is it that taking more aggressive action was not considered or acted on?
  • Was there fear that a more aggressive, and outside of policy, plan would have resulted in retribution?
  • Did these crazy rigid rules have such a stranglehold on people that they ceased to care?

Regulations & Culture

There are four big lessons for senior living in this story:

  1. If you are operating in a heavily regulated environment it takes enormous will on the part of management to create a culture that provides care above and beyond the rules and regulation. There must be a culture that allows team members to break the rules if a resident benefits.
  1. It seems as if the senior living trade associations that represent the interests of skilled nursing providers have entirely conceded the regulatory battle. What I mean by this is that there seems to be no interest or desire in pushing for a major revamp of the regulatory system (starting with a clean sheet of paper) that would have as an end result sensible regulations that would swiftly and harshly punish or shutdown bad operators and allow good operators more room to create really amazing programs.
  1. It is further evidence that ALFA (Assisted Living Federation of America) is on the right track. ALFA is developing a set of best practices for assisted living communities as a way to slow down or stop the push for more regulations, a move that will ultimately hurt residents and increase costs.
  1. Too often post-acute providers implement so many policies, processes and procedures that they become as stifling as regulations imposed by the government.

It is easy to see these things as someone else’s problem or as impossible to solve. I am not willing to accept that. I can’t help but think the industry being apathetic is at least part of the reason the skilled nursing environment is as burdensome as it is. Steve Moran If you like this article (or even if you don’t) it would be a great honor to have you subscribe to our mailing list HERE

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If you like this article (or even if you don’t) it would be a great honor to have you subscribe to our mailing list HERE

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