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Extreme Application of Protocols, Standard Operating Procedures

and the Impending Struggle in Medical Practice

Originally Published by Data Driven Investor on Medium


Photo by Sam Jean from Pexels

As personages of a communal from the time we awaken up to fall asleep, how we live, interact, and function comprises multitudes of the call to action. We are relentlessly absorbed into executing the same or at least similar tasks day in and day out. Concomitantly yet unconscious, we search for ways to complete those repetitive errands uniformly, nonetheless, efficiently. We diligently propagate unconscious studies of creating standards for a process, action, or thing as a way to simplify our day to day deeds or as something to set up and established by authority as a tenet for the measure of quantity, weight, extent, value, or quality of what needs to be at the more significant latitudes. Today, the standard concept is being applied in thousands of organizations to countless settings, from technology such as international manufacturing standards to medical practices under the so-called "standard of medical care."

As indicated earlier, many reasons exist for an entity to embrace a set of standards. Within the mainframe, regardless of how often a single task is performed, it requires rules that define the scope, quality, and methods that are to be followed. If not standardized, it will fail to support visibility over ensuring quality and reducing human error.

As no controversy to some degree of regularization, the biggest argument is not necessarily why we need a standard guideline, but how essential it is to put in place the necessary protocols and procedures without inviting a conflict of interest.

Every standard is restricted by a unique point of reference that serves as an accepted fixed tangible or intangible theme of coordination or compassion. Any deviation from the allusion would function as a measure of quality, efficiency, or acceptability away from the established standard.

One of the significant challenges of the normalization design is accounting for the elements that are subject to change and the features or factors that are liable to vary. The concept of variables is noteworthy in situations that directly impact human life, such as medical practice. The variables and the point of reference are a couple of constraints; unless dealt with in the environment within the individual's vicinity, it would be subject to overzealous susceptibility. So, who, how, for whom, and where the standards are created is of utmost importance.

Medicine is the science of indefinite variability, and respecting individual humane values thus is the virtue by which they dictate the standard and context should be appropriated.

The extreme application of the definitive standard is a prerequisite to discriminatory profiling, segregation, and bureaucracy. It would, in effect, dictate any action by the benefit of overriding the inconsistencies through the creation of standard operating procedures (SOP) and guidelines, by the way, of a solo or collective deed of popular majority bases.

To translate standard into the so-called standard operating procedure (SOP), one requires developing a protocol that, in succession, would function as the rule under which any particular process is executed.

The standard operating procedure (SOP) is a series of step-by-step directives accumulated based on agreed standards to ensure proxies fulfill complex responsibilities proficiently, uniformly, and to the expected near quality while reducing miscommunication and failure to follow industry guidelines.

As elucidated earlier, to show and capitalize on the quality, value, and efficiency of a product and services, Protocols, guidelines, and SOPs can be valuable tools in technology, as they are applied to a great extent in every industry. The manufacturing with a tangible product or fixed form of deliverable where scarcer variables constrain the superiority and worth of its derivative stand predictable. On the contrary, in the healthcare industry, where human variation is as expansive as the number of individuals globally, one should anticipate a significant conflict of interest if the standardization is rigidly applied. Hence the one-size-fits-all across the board widespread solicitation of standards for the entity, technology, and human life cannot be strong-minded through a shared universal approach. One may presume that is what is now being entertained within the framework of our current healthcare system. But the evidence suggests the contrary.

Why standardize human life?

Is it to improve the quality of care or improve control, or is it about micromanagement?

At some point, undiscerning tender of protocols and guidelines in the face of broader variability and biased point of reference would lead the system out of quality assurance into the controlled reassurance, thus supplementing the side by side control along with licensing and certification.

As much as a helpful tool guideline and procedure is to the entities, more so for technologies, its unnecessary use in human life bears a metaphoric resemblance to slavery. It commoditizes human life through radical rectification into what would be applicable in robots or Artificial intelligence.

In the 21st-century, medical practice protocols and guidelines dictated by the common population health approach have been arbitrarily entrenched in different aspects of patient care encompassing from the spectrum of a preventive medical course of actions to facility operations. In selected circumstances, medicine has benefited from procedures. But, in general, we are ill-fated by its unsubstantiated and indiscriminate administration. Their liberal executions in medicine resemble the obscure shackles in the modern terms of slavery.

Application of the SOP and protocols in healthcare is an intricate state. If applied broadly by overlooking the rudimentary constraints, it would more than not have a paradoxical outcome. For precedent, the standard of medical care is a commonly utilized legal term applied within medicine. It serves as a judicial instrument in the medico-legal litigation procedure. Yet, in the current medical environs, the locus and the variability of the standard of care are vague.

In larger healthcare organizations, establishing the standard of care has been attained by crafting proprieties to shedding light on the dark side of medical malpractice to solidify what is indeed a deviation from the norm. With the adoption of Protocols on a large scale, the outcome would set in motion bureaucratization of the medical practice. Without modus operandi and guiding, the principle physician must foresee defensive argument by shopping around for peers who support the approach in the court of law which the defending physician has chosen for a particular patient. The two extreme setups probably would carry two different arrays of controls, but perhaps similar outcomes, wherein legal footings may or may not favor the plaintiff or the defendant.

Person or entity responsible for approving the executed protocols or, in the latter case, an expert who is testifying would indeed have a different stance on the standard for that particular patient under distinct circumstances.


The vicious circle of government micro-management, bureaucracy, Standard operating procedures, more protocols

Medical practice procedures, like other SOPs, are dictated by the upper level imposing protocols along the chain of the administrative hierarchy. For instance, if a medical facility forecasts to inaugurate a practice set for the treatment of community-acquired pneumonia, irrespective of what and how the treating physicians choose to prescribe an antibiotic, he must select from the set of drugs that are approved and recommended by the Food and drug administration (FDA). Or, in some cases, they have the choice of prescribing from the list of formularies permissible by the patient's insurance carrier, further narrowing down the number of antibiotics to pick from the list of approved options by the FDA.

Standardization procedure is the way to micro-manage an autocratically inclined administration system where most processes constitute a rigid but straightforward top-down reflection of the ranked approach to what central command intends to dictate.

Reflecting on the current healthcare crisis

We hold the mainstream population of individuals liberated by decades of a free flow of Internet data and independent research potential. They represent patients who intuitively practice their liberty by developing higher expectations and a personalized view of what they need. On the other end of the balance, we retain a healthcare administration spending billions of dollars to start a series of standard guidelines, legislation, and procedures. The kind of procedures to inset top-down enforcement of inflexible solutions by hand-to-hand fleeting along with the instructions one division at a time and subject to modification by every single hand it shifts. Such an approach under the utilitarian concept has worked for centuries, which necessitated passive participation by the constituency. But, its shortcomings have been proven inevitable.

The current patient mindset would install to a workable extent; the predilection to broader constraint at the smaller population sample. The ongoing system of the population health delivery model would take into account the social determinants of the quality and value at a much larger community section. Hence dictating the care of marginal by incorporating the general population dynamics using predefined points of references, as the end of the chain of the administrative ladder may not be in line with the positive outcome and satisfaction of the individual patient

Physician practices are under tremendous burden by the existing system of healthcare delivery. The organizations with authority to regulate and start a cookie-cutter medicine using unbending strategies would prevail. But with a significant flaw; later size. As the organizations openly taking part in patient care grow over definite magnitude, the bureaucracy would triumph- patients, physicians lose autonomy and control over their bodies.

Solution

An effective healthcare solution can't take place without solid groundwork. The challenges that pertain to Breaking the liberal application of rigid protocols in medicine are too overwhelming even to consider a top-down makeover.

Independent Physicians are missing one or more elements of what I call prerequisite for medical practice reform. Those of five (5) pieces are:

1. Learning — "Knowledge is power. Information is liberating. Education is the premise of progress, in every society, in every family," Kofi Annan, the Ghanaian diplomat who served as the seventh Secretary-General of the United Nations, once said.

Knowledge is the key to any door, as essential to learning about the roots of the problems we are facing.

2. Adapt — Knowledge along with persistence is the fundamental prerequisites for adaptation. Adapting to the ever-changing environment aligns the individual one step ahead of the game by providing the ability to win over the challenges of the system, regardless of its quality and nature.

3. Prevail — once adapted, the person can overcome the obstacles associated with the flaws of a system, clearing the path to excellence.

4. Excel — Those who excel at existing tasks are mostly the ones who will plan better solutions in the future. Hence they are considered the true pioneers of reform.

5. Reform — the change to betterment of the system is not the end of the road but the opportunity to learn more and prepare for the more challenges coming further reforms to make.

In the face of overzealous standardization and profiling, the contest against healthcare glitches at the top will set in motion additional standards and bureaucracy, thus repeating the vicious circle of mandates and authoritative injunctions. As an alternative, all standard operating procedures must be narrowed in the scope of application and the focus.

Smaller the community dimension would mean an insignificant variable element profile, focused precise point of reference. Latter is achieved through decentralization, yielding more direction of orientations within the immediate municipal around every patient. The administrative overlook of the role must ultimately encompass high-level macro-management, less organizational interference in professional clinical judgment, and more top safety, security, and quality assurance oversight.

#SOP #Protocol #standardoperatingrocedure


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