When competition should be at the hospital level

In my previous post, I listed some of Michael Porter's criticisms of the health care industry. One of his main points was that competition is organized at the wrong level --that of the hospital. And he also criticized the quality movement for focusing on top-down, "Soviet style" micromanagement and process compliance initiatives.But an Associated Press/Boston Globe story from Saturday (Hospitals sharply cut patient complication rates) illustrates the benefits of hospital level competition and process compliance. The article describes efforts by hospitals to prevent pneumonia and blood infections among hospitalized patients.

In New Jersey, 25 hospitals working with [the Institute for Healthcare Improvement] reduced ventilator-pneumonia cases and catheter-related infections by a third between last June and January, and cut the average patient's ICU stay by three-fourths of a day to a total of 3.5 days. They followed simple steps such as weaning patients off ventilators more quickly and using a stronger skin disinfectant when inserting a catheter, said Aline Holmes of the New Jersey Hospital Association.

The goal is ''trying to make things as idiot-proof as possible," she said.