Policy vs. Practice
Joan Moore
HCM 600 Social and Organizational Issues in Healthcare

Policy vs. Practice
On any playground in your town, you find a teeter-totter, where one end of the board is higher than the other end and rarely is the teeter totter level unless leveled by two cooperating individuals. So is practice and policy the two riders on the healthcare teeter-totter. It takes a cooperative effort on the part of healthcare providers to balance the teeter totter and provide valued care all the while meeting the requirements of policy.
As an example of policy vs. practice, evidenced based medicine is an increasingly valuable tool in healthcare. Evidence -based medicine (EBM) is commonly defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Timmermans and Mauck 2005). One common implementation of EBM involves the use of clinical practice guidelines during medical decision making to encourage effective care. The Institute of Medicine (IOM) defines clinical guidelines as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Practitioners can use EBM as a statistical meta-analysis of accumulated research, to promoting randomized clinical trials, to supporting uniform reporting styles for research, to a personal orientation toward critical self-evaluation in their search for the best treatment within the guidelines stated for the illness presenting. Thus, EBM and guidelines serve as a tool for practicing healthcare providers and their patients to achieve the most cost effective and effacaious healthcare available. As it stands today, EBM is a separate and (can be) a time consuming task that a healthcare provider undertakes to arrive at the best treatment. To be utilized more consistently by physicians perhaps the marriage of the EBM technologies and the EHR can be facilitated. If EBM data were available during the clinical decision making the extra step of analyzing of research could be done in the examination with the patient and thereby reduce the “other waiting room” time. This would also allow for patient input and provide a trust affirming interaction with the physician or other healthcare provider. In terms of policy, the inclusion of the EBM in the EHR can address Meaningful Use as well as allow the physician to practice medicine. Although practice is not the term that best describes this process, patients don’t visit a physician for practice, they visit a physician for expertise and healthcare solutions just as we visit a mechanic for their expertise in car repair. By streamlining policy and practice there stands a chance that healthcare will be a value based experience from all stakeholder’s perspective.
Policy vs. practice? If policy is compromised, eventually practice will be compromised as well. By not attending to governmental and industry oversight a healthcare provider is jeopardizing their very existence. Additionally, the end results can be significant penalties, revocation of licensure, nonpayment for claims submitted and the loss of the business. If practice is compromised, the results can be just as devastating with mal practice lawsuits, a tarnished reputation, loss of income and the ultimate – the closing of the business.
Whether in healthcare or in the restaurant we frequent, there are policies that need to be followed and the practice of the business. Compromising one for the other, results in a sub quality experience for the consumer either by exposing them to a greater risk or delivering a service that is unacceptable frivolous and costly. It is the integration of policy and practice that allows the healthcare industry to provide cost effective and quality care. It is the neglect of one or the other that seems to result in increase costs, dispariate care and costly health insurance.

References
Timmermans, Stefan and Mauck, Aaron (2005). The Promises and Pitfall of Evidence Based Medicine. Health Affairs 24:1 doi: 10.1377/hlthaff.24.1.18.