Healthcare and Operational Transformation

I don’t believe, in a 10 year period of time, we are going to appreciably alter the process of actual clinical care.  That is to say, going to the doctor 10 years from now is not likely to be a different experience than it is today.  If we think back 25 years to our experiences with medical care, there has not been significant change… despite, the trends of patient centered care, HMO’s and a barrage of other well meaning clinical care trends.  I think there are a number of characteristics of “medical care” culture that make altering its behavioral and cultural paradigm very difficult.  It is ultimately a very fragmented professional body… many individual professionals and numerous practices without a technology to appreciably facilitate a change in clinical practice behavior.  The real estate profession was similarly locked into a specific behavioral trend for many decades until the internet forced a change in practical behavior.  The clinical lobbies and commercial enterprises invested in clinical practice not changing are considerable.  So how can change really be affected?

Politics vs Economics and Healthcare

As a new blogger… I have started following a number of healthcare blogs.  One I find interesting is Action for Better Healthcare.  The December 3^rd posting asks if it is reasonable to fix the issues with the bill after the election… the argument being offered by those in the house supporting the reform bill.  I would say, at a minimum, it is a very risky strategy for such a large percentage of our economy.

We inside healthcare are not mistaken when it comes to the social and operational complexity of our sector so I am not surprised at the rush to get the healthcare bill passed given the political reality of house elections next year. After all if the real issues are debated… the bill will, at a minimum, stall and most likely will fail.  I am surprised, however, that even the basic realities of supply and demand are not being argued by those in our country, both inside and outside healthcare, who understand the fundamentals of economics.

Are our elected leaders chasing the wrong healthcare dream?...

Perhaps our elected leaders are chasing the wrong “system aim”...  The white paper Hospital Operating System - Unleashing Throughput Potential references the importance of system aim, an idea popularized by Deming. What if our leaders altered their approach and pursued affordable delivery of care rather than coverage as our system aim for healthcare? Would we be taking a different course of action?...

Does the Healthcare Bill skip the basics?

The last time I checked… if demand is increased relative to supply… prices go up. So if we add millions to the healthcare roster while at the same time the incentives for clinicians to excel in their profession are diminished, isn’t the demand for care increased at the same time the supply of care providers is either stagnant or potentially declining. As there has been in the past, those who have succeeded and been rewarded for their achievement have a choice to either stay in the system or dial back their contribution as the conditions they exist in become less hospitable. A star athlete in high demand is likely to seek out the team who will provide compensation more aligned with his/her self perception of value.

The status quo will fight for survival.

Picture it... "A healthcare leader has a vision that could radically improve the efficiency or operating success of an organization... the clinicians or community fight for the status quo... the leader either dramatically reduces the vision and abandons the plan or in some cases is asked to step down". When faced with radical change, the healthcare ecosystem, like all organisms, will fight for its survival.

If you consider the challenge facing our national healthcare system, namely an inability to sustain the cost of delivery, iterative improvement is not sufficient. Sustainability of our leadership position in healthcare will only be possible if we can achieve dramatically better levels of efficiency, very quickly. So the very levels of change needed are likely to be met with substantial opposition… the survival instinct of the status quo.