As physician, healthcare executive, academic scholar, author, advisor and, most importantly, a patient, I propose the answer to our current healthcare dilemma starts with a laser-like focus on getting patients exactly what they need at continually lower cost. But current healthcare proposals are offering more of the same.
Over the last 40 years, I have heard that we shall transform healthcare by the exact same solutions proffered to Congress by health care industry leaders this week: simplifying administrative costs, making hospitals more efficient, reducing hospitalizations, managing chronic illnesses more effectively and improving health-care information technology.
Yogi Berra said it best: "It's déjà vu all over again."
We are not going to transform healthcare by trying harder at 1978 ideas. Trying harder will instead deliver exactly what it has already delivered -- less care at higher cost
Trying harder is simply rearranging a few more deck chairs on the Titanic -- it might improve the appearance of the healthcare ship, but it will continue to leak and it will inevitably sink. The recent announcement of the eminent insolvency of Medicare Part B suggests our Titanic is taking on water a lot faster than we anticipated and we have a limited number of very antiquated lifeboats with which to save ourselves. We better start building a few more lifeboats fast.
Fortunately, there is a simple set of principles for building more lifeboats and eventually constructing a much better healthcare ship.
To begin, we must recognize that healthcare transformation is not dependent on what we have done in the past or are doing now, but rather on how we adapt what we are doing to a constantly changing environment.
We also must recognize that the structures and systems of current organizations and the habits, behaviors and values of the people embedded within them will usually slow, stall and stop adaptive change. This is an organizational fact of life developed by Harvard Business School Professor Clayton Christensen in his concept of disruptive innovation, and most of us have experienced it.
Therefore, healthcare transformation begins with those few organizations strategically and operationally "designed to adapt." These organizations have incredible competitive advantage in a rapidly changing world. They represent the opportunity. They are where we will make the new lifeboats for our sinking ship.
Christensen says it is almost impossible for an established organization to lead disruptive change. But, if it's "almost impossible," that means it's possible. It means that we can expand the adaptive potential of established organizations, and in doing so, expand the possible solutions for healthcare.
How do we build adaptive organizations? We follow the methods that create great innovations. In healthcare, these methods have been proven to work in many organizations. Here's what the process looks like:
1. Find a place to start close to the patient.
2. Focus exclusively on getting patients exactly what they need at continually lower cost.
3. When that fails to happen, understand why and then rapidly problem-solve the system.
4. Use discipline and structure to rigorously test and validate the solutions.
5. Develop the knowledge and creativity to replicate what works as rapidly as possible.
Working adaptively means developing, leading and challenging the knowledge, creativity and problem solving ability at the point of care, not by sending more data up and implementing more big solutions down, as we have been doing for 40 years.
This time, rather than rearranging the deck chairs on the Titanic, let's develop, coordinate and control problem solving and improvement where the information already is -- in the workplace, at the point of care.
This isn't to say government has no role in transforming health care. Becoming more adaptive requires organizations to work differently and that requires strong leadership. Government can help by creating the safe harbors that encourage adaptive work. It can build the places where management, caregivers, unions, insurance, industry, employers and patients can come together to learn to work differently. But government must be willing to adapt its role. If it does more of the same, we'll all drown.
Dr. John Kenagy MD, MPA is a former Visiting Scholar at Harvard Business School and the author of the forthcoming book Designed to Adapt: Leading Healthcare in Challenging Times (Second River Healthcare Press, 2009).
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The reason the US became the greatest country in the world was because the fathers of the country managed to take the best ideas from the different immigrants and consolidat
The reason the US is decades behind these same countries in regards to civil rights and medical care today is because; "we know best".
I have received medical care in Norway, Denmark and Canada where they solved these problem decades ago.
I have also been a member of several HMO's including Keiser, Scott&Whit
While a majority of Doctors are the best people on the planet, desiring to help humanity, in the US Doctors in HMO's are handicappe
The problem of excellent medical care has been solved in the rest of the world a long time ago; the solutions you are proposing Dr. Kenagy is just more double-tal
Unfortunat
Ironically as more people are being swept into an Americaniz
The Americans you know are entirely different from the one's I have had the pleasure of becoming acquainted with: As a matter of fact the one's I know would have been extremely insulted the way you categorize them.
And I appreciate also how this may seem like double-tal
One of the big difference
So, frame the action on getting patients exactly what they need at continuall
Hospitals have spent there monies wisely, have color-code
Finally, we’ve created a series of checks and balances in our healthcare engine that should help it stop leaking oil. We’ve given everyone a haircut to one degree or another but we’ve refocused on the fact that the goal of our healthcare engine should be on providing better healthcare for ALL Americans and that profits should be earned though innovation and hard work not just by exploiting leaks in the system or clever accounting
The other thought is that when designing the XML processing procedures it should never be pigeon-hol
Now the medical office worker, physician and patient all check the accuracy of the EMR. From the physician’
But the issue here is to design a system that separates informatio
So What's needed is a third-part
This allows for the creation and refinement of many backend programs that can check on the validity of treatments in so far as medical errors and options are concerned
Next up are the healthcare insurance providers. Because the medical community has its own very precise terminolog
We left the medical records as electronic medical records earlier we need to get them into EMR but I’m of three minds here. The first is that we could have done the conversion when the records were scanned in and using software and our census workers create the EMR, this provides the greatest stimulus to the most people. Or we could scan them in and have the conversion done in places like Elkhart, Indiana or other areas hard hit by this recession. But we could also write software programs to parse, categorize
At this point we’ve minimized the risk of movement to XML. The physician’
The largest cost savings and reduction of medical errors comes not from the EMR record but from the workbooks. This type of workbook is really a best medical practice workflow, in it’s infancy it’s just an electronic record of symptoms, treatment and justificat
At the hospital level we could use the same type of system as at the physician’
Next we need to look at what is the correct paradigm to use for our medical records. This is simple it’s an electronic loose-leaf notebook that mimics a paper folder but has pages that can be forms or entire computer systems like an MRI system. A simple example would be using the Kindle II to access medical records. Because most physicians medical records are in paper form we need to get them scanned into electronic form and sent to the telecoms. This is labor intensive but requires little training; we could use the workers already being assembled for the 2010 census, providing a very quick stimulus effect across the country. This is not make-work because the unfiltered raw data is the most valuable form of informatio
I want to keep this letter at the concept level and not get into a technology whitepaper
There are currently three basic types of medical records,pa
The first discussion we need to have is who should hold these records. If the goal is to fight disease, find new cures, to identify epidemics and to use these records as a basis for an unparallel
I believe there is a huge opportunit
You are exactly correct in your thought that what has been discussed so far is merely re-arrangi
But then again, I guess there are people who would rather drink poison than to continue wandering the desert looking for the oasis that's just over the next sand dune
I seek to reframe the argument by starting with developing the front line to be able to get patients what they need at continuall
The only way we can have real reform, is to take the for profit insurance companies out of the equation. They have shown that they will sabotage/l
1-Allow employees to increase their contributi
2-add 1penny tax to all fast food and alchohol sales.
3-build small, fully equipped wellness clinics throughout urban, low income and rural areas. Staff them with Doctors and nurses who will then be able to deduct their student loan interest on their taxes for the whole time there, or until paid off. Keep 1 or 2 peds nurses/mid
4-these clinics should have extended hours, say 7am to 10pm to accommodat
5-they will also have a 24hr on call fam practice doctor for minor emergencie
These clinics will charge as a copay whatever folks can afford. Medicare will be allowed to negotiate lower drug prices or get from Canada.
If this happened, I think we would have a healthier nation in 1 generation
You have great ideas. We have no shortage of great ideas. What we lack is a structured
That takes a different approach. Many colleagues and I have been testing and validating the concept of starting with the patient and working back adaptively
The key to this will be to Keep It Simple Stupid. We need a single payer system based on patient access to care and low administra
But insurance costs are only one of a multitude of very expensive Iron Rice Bowls. Unless we solve the problem of getting patients exactly what they need at continuall
That’s why I champion using Adaptive Design to create a new common “Rice Bowl” centered on getting patients exactly what they need at continuall
I mean, all we really need is a Doctor, a Patient, and a minimal amount of Administra
It's time for Universal Single Payer Health Care for the people of the United States paid for by a national consumptio
The insurance/
In my experience
Thank you, thank you thank you! This is the FIRST article on Huffington
The only criticism I would have is where you say "Governmen
I would change the order somewhat and say that patients come first, then care givers, then insurance, industry, unions and government
But, this is an excellent start, and a real first stepping stone to putting the patient and our HEALTH and its care above the bureaucrac
They still have insurers in Europe who process the claims and are EFFECTIVEL
And we can do this by institutin
Historical
So another way to look at healthcare transforma
And these ideas are not theoretica