Financing reform without care delivery reform would be a major operational and economic error. Care delivery in the U.S. is uncoordinated, unfocused, inconsistent, unmeasured, extremely inefficient, perversely incented, excessively expensive and sometimes dangerous. Health care delivery is, however, the fastest growing and most profitable segment of the whole U.S. economy.
George Halvorson, CEO of Kaiser Permanente
Month: April 2008
The problem with health care: too many cynics
“Cynical people aren’t engaged in trying to make things better.”
Those the words of a leadership guru speaking on new world realities, specifically on the theme: The Cynics are Winning. While he was talking leadership, I’m talking health care.
“Cynicism is the tendency to be close-minded and disillusioned,” according to Kouzes and Posner.
The guru also cited a study that said half (that is, 50%) of the people in the United States are cynical. Well I figure that the health care industry employs over 12 million people (and growing). Mix in politicians and health care’s tendency to have issues with change generally, and I’m going to go ahead and guess that the majority of people involved with health care’s future are cynics.
There’s no other explanation for why we’ve been talking about problems in health care for 40+ years while watching safe, incremental change move along at the pace of an inchworm. And costs generally keep going up—more like the pace of a horse’s gallop.
Health care’s cynicism has got me sounding like a cynic, now. Well I’m cynical toward cynics. (I guess we can all be that way from time to time. But collective cynicism for 40+ years? Come on!)
Concierge medicine doesn’t deliver care fairly (and the current system is better at this how?). Continuity of care between PCPs and retail clinics is poor (as if all other providers communicate well?). And electronic medical records are too dangerous (the mounting number of medical errors are a fair trade off?).
Tom Peters has said, “It is an age that begs for those who break the rules, who imagine the heretofore impossible.”
There will be never be unanimous agreement on any health care innovation. There will be issues with every potential solution.
But gosh it beats inaction. It beats sticking with the same model that obviously isn’t working well. Let’s try new things. Let’s work through the problems that arise. I’m hardly arguing for tearing down what we’ve got. But don’t be afraid to experiment. Embrace experimentation.
Health Care Privacy in a Facebook World
Start a conversation about electronic medical records and the topic of privacy is sure to come up…if you’re talking to someone over 30.
I’m not sure it’s a good thing, but I get the feeling that individuals who were fortunate enough to have been in college when Facebook went viral care little about privacy. Yes, it’s possible to only share your profile with friends, but if you have over 1,000 friends, I’m not sure there’s much difference between your network and the world.
The point here is that our concerns with privacy have led, in part, to inaction on the implementation of an electronic health record. And the larger point is this: enough already.
Jen McCabe Gorman has a wonderful post at Health Management Rx on exactly this topic (so, it’s safe to say my post was inspired by her post). Here is an (relatively giant) excerpt, but go read the rest:
We need to stop pretending healthcare is the industry in which our vulnerability opens us up to the most potential for avaricious theft and misuse of data.
This is a naive, overly simplistic excuse used to dismiss the end value of using personal health records and giving consumers shared control over the co-creation of a personal health narrative.
Get over it. We already co-create our personal health narrative – what do you think a history and physical interview consists of? The doc asking questions, the patient giving largely subjective answers, and then that information being ‘objectified’ and codified into that provider’s medical record.
What slays me is that we do this over and over and over.
Talk about inefficiencies and misaligned incentives rampant in our healthcare system…we have to recreate meaningful interactions and establish a solidified platform of shared data at the beginning of EACH and every visit with a healthcare provider.
And it’s not new information, building on backstory to establish timely relevance, it’s the same old H&P data that’s stored 500 other places in disjointed medical records.
If my doc could access my personal health narrative and then ask questions directly relevant to my history (“Still having trouble falling asleep?”) we might actually get somewhere in the 2.45 minutes she has to sit and talk with me before tearing off a prescription sheet.
This is an old, tired argument.
Warnings of privacy issues with medical records. Calls for more security measures with online records. Concerns with health information falling into the wrong hands.
We get it. But it’s never going to be perfect. That’s the price we pay for instant accessibility. So just deliver us a product that we can use, want to use, something we can’t (literally) live without.
The Globalization of Health Care Delivery
It can be said that when it comes to introducing business innovation into practice, the health care delivery industry is usually behind the business world by about 10 to 15 years. Think electronic medical records, organizational structures, service delivery models. While it is easy to look at the negative aspects of such a reality, there are two sides to this coin. Watching business-changing trends take hold in other industries years before they affect health care can allow the health care industry to plan and prepare for drastic change.
Well, here is an opportunity: the globalization of health care delivery.
It’s happening. While some American hospital-affiliated organizations may be involved with health care delivery overseas, like in Dubai’s Healthcare City (official site here), it is not necessarily required. The best of American health care has set up shop in the Gulf region: the Mayo Clinic, Cleveland Clinic, Harvard Medical School. But countries like Thailand and India (and pretty much everywhere else) are luring Americans toward destination health care at organizations with little American affiliation.
In an era of rapidly rising health care costs, diminishing insurance coverage, and increasing value expectations, seeking care overseas has increasingly become a viable option. The term medical tourism has been around for a few years. Widespread diffusion of the idea is expected. And why not? Patients can seek care from U.S. trained physicians at a fraction of the cost (round trip airfare included).
According to this article in Fast Company, “As many as half a million Americans streamed abroad last year in search of affordable alternatives for hip replacements or prostate surgery.”
Worldwide health care delivery will not just be an option for the uninsured or the financially strapped American. American insurers are knee-deep in the trend:
And if all this sounds a bit outlandish, brace yourself: The big insurers are already looking into it. “Once they understand the ramifications of this, you’ll see the larger players start crafting policies that allow people to receive treatment overseas,” Ori Karev, CEO of UnitedHealth International, the global arm of the UnitedHealth insurance conglomerate, told me. “I think you’ll find most of us exploring this. We are a business at the end of the day.”
What does this mean? It means we need to get our health care house in order. The best medical care in the world takes place in this country. It just doesn’t happen everywhere in this country. We must take steps (NOW! so yes that may mean individually by each care organization) to ensure the highest quality, highest value medical care in every medical instance in the U.S.
So go read the entire article if you haven’t already. This trend will have a major impact on health care in the future. Worldwide health care delivery networks are a very realistic possibility (and that’s not necessarily a bad thing).
Let us take a lesson from the auto industry on the impact of global competition. While U.S. auto makers move manufacturing out of this country, foreign auto makers move production into the U.S.
It is time to get competitive on value, not just with the hospital down the road, but with the hospital over the ocean. Globalization creeps. Before you know it, it may have the U.S. health care industry in its grasp.
Learning by Surfing: Issue 2
A gathering of good stuff (health care related) around the web…
Maggie Mahar at Health Beat explores the question, “Can we reach a consensus on what we need to do to achieve meaningful health care reform in the U.S.?”
Yet there are still major issues that could divide reformers: Should we acknowledge that we won’t be able to cover everyone unless we learn to “control costs”? Should we move directly to a single-payer system? And finally, should we try to move quickly, to cover everyone, or should we aim for incremental progress while sticking, stubbornly, to first principles?
…
Dr. Scott Shreeve on the personalization of medicine:
So lets start this out by talking about the personalization of medicine. This is typically thought of in a genetic sense, wherein people are customizing medications and therapies based on your individual genetic profile. Said in other words, the “Right treatment for the right patient at the right time”. However, most consumers already assume Right/Right/Right is happening, and more likely consider personalized medicine as a type of practice delivery style. This is where the physician knows the patient intimately, their social and demographic context, and the correct diagnostic or therapeutic approach given the patient’s preferences that have been learned throughout the relationship.
…
Jen McCabe-Gorman was blogging from the World Health Care Congress this week and posted her thoughts on a developing theme: the medical home concept.
The medical home is about primary care. Primary care puts patients “primarily” at the center of the care spectrum.
The medical home is about care coordination. Care coordination is about putting the patient “primarily” at the center of the care spectrum, and then ensuring they stay there as they seek services at different locations.
Unfortunately, “primary” patient-centric, consumer-directed care in the US has devolved into the desperate pursuit of paperwork needed for payment.
…
Nick Jacobs, CEO of Windber Medical Center, writes how his hospital is able to keep infection rates low at Hospital Impact:
Recently, we once again produced annual infection rates that are well below the average national rate of nine percent. In fact, they are eight percent below that figure. Although I believe that our outstanding success is due to our total and complete commitment to patient centered care, for those of you who are in need of more quantitative substantiation that is less subjective, we decided to provide that for you as well. So, we went directly to the source, our infection control specialist, Carol, and asked her to elaborate on some of the steps that she takes on a daily basis.
…
The Health Blog talked with a few Democrats this week. They aren’t particularly optimistic of health care reform:
While the candidates talk about plans to cover the country’s 47 million uninsured, some congressional Democrats are, shall we say, lowering expectations.
Customer satisfaction surveys are useless when…
I had to get my car serviced today at the dealer’s service center. It was about as enjoyable as you could expect a 90 minute wait to be. But as I was waiting for the paperwork to be completed I noticed a sign in the lobby of the service shop that read (I snapped a picture with my phone, but its quality is too poor to post, further, all the grammatical errors were on the original sign):
Attention: Please
We work hard to provide you with the best possible service we can give you. Part of this endeavor includes a follow up survey conducted by XXXX on your experience with us. In essence this is our grade card.
Please keep in mind that XXXX considers Yes and 10 an acceptable or passing grades. Any and all other responses are considered unacceptable and / or failing grades.
If for any reason you feel you would not be able to grade with a Yes or a 10 Please call Our Service Manager XXXX XXXX.
Thank you,
XXXX XXXX Service Manager
Couple things:
1. If your service needs to be a Yes or a 10 to “pass” survey inspection, you probably shouldn’t be reminding me to give you that score. Make my experience with your organization a Yes or a 10. Your service should be so excellent that the customer needn’t reminding. Period.
2. What is the point of customer satisfaction surveys if it is pass/fail? You know, my service wasn’t that bad, but it wasn’t that great. And since I’m willing to comply with your request, I’ll give you a 10 or a Yes. But does that ever help make your service improve? I’m willing to bet your service is generally pretty good and you get very few negative responses. So while your service is going to generally be very good, what help is it to your organization to not use customer satisfaction surveys for improvement? Your service today may be good enough, but in the world we live in, good enough today probably isn’t going to be good enough tomorrow.
This happens in health care, too. It has happened to me. I went to a clinic lab to get my blood drawn a few months ago and the lab tech asked me to fill out a customer satisfaction survey before leaving. He stood over me as I filled it out and reminded me that anything lower than a 5 (on a 1-5 scale) was considered failing.
I understand we don’t want to fail. I understand that we want our customer service to be rated highly. But what is the point if it is just a mirage? If you’re going to collect data, collect it with a purpose. Your customer satisfaction is a very important component of the patient experience. Don’t set yourself up for failure by polluting the data and setting subjective benchmarks.
Health Care Around the World by the Healthcare Economist
The Healthcare Economist has spent the previous two weeks synthesizing a comparative study of health care systems around the world. We often hear about the positives and negatives (depending on one’s agenda) of care delivery in other countries. Below are links to concise and informative summaries for comparative use.
France | Italy | Spain | Japan | Norway | Portugal | Greece | Great Britain | Switzerland | Germany | Canada
Saturday Humor: Medical Waste
[youtube:http://www.youtube.com/watch?v=xskFo75Wdhs%5D
A play on a couple of hospital myths/realities.
15. Department of The Best Start
our own system’s Department of The Best Start will be responsible for greeting and helping patients, families, and visitors when they walk into the lobby.
We borrow the job description from the blog of Beth Israel Deaconess Medical Center CEO Paul Levy: employees in the Department will “answer all kinds of questions, give directions, escort people to their appointments, and are otherwise exceptionally pleasant and helpful.”
Simple, right? Not always. Smiles and hellos are not always pervasive in a hospital. But what better to help sooth a patient’s rattled nerves as they enter a hospital than a friendly, smiling face?
The distinction between a run-of-the-mill staffed hospital lobby desk and the Department of The Best Start is a move from a static office desk dedicated to answering questions by those who approach to a constantly mobile group of individuals dedicated to the patient experience by seeking out all who walk through the front door.
Innovative patient experiences is really what the Department of The Best Start is all about. This group will always be on the lookout for ways to improve the patient/hospital interaction. At BIDMC, they have interpreters in over 30 languages and have “a rotating box with instructions in several languages to help people who do not speak English get the help they need.”
The Department of The Best Start will be the dedicated Relationship Builders between those entering the hospital and our own system. If patients start with an enjoyable beginning we know that there is a better chance their entire experience will be positive. And it all depends on communication.
As Mr. Levy writes on his blog, “Good communication is not just a pleasantry in a hospital: It can be a matter of life and death.”
Principle #15: Beginnings matter. A lot. As we move to a competitive hospital world where patient satisfaction actually manifests into return visits/word of mouth marketing, how we build relationships with those who enter our organizations will become vitally important. We’re just getting a head start.
Our Past Necessitates Our Future
Questions. Lots of questions. Questions about what we want reform to look like. Questions on how we are going to go about it.
One thing all have in common: cutting/lowering costs. Revelation (no, not really): One man’s costs are another man’s profits.
Here’s another question: Who is going to compromise? Not doctors. Not hospitals. Not insurance companies. Not device makers. Not drug companies. Not anyone else. At least willingly. So it falls to the patient. And this time, I don’t think patients are going to stand for meaningless pandering either.
So our path dependent policies and our way of doing things for oh-so-many years complicate the heck out of reform. Noted (and proven again and again). Some are pessimistic about reform in the coming years (rightfully so?). Positivity (sadly) is getting harder to find and we don’t even have a new Head Honcho yet.
Our incrementalism may not work here. Transformational, revolutionary, rebellious change may be the key. The fear: instead of choosing meaningful reform, our old ways of doing things chooses reform for us.
Our past necessitates our future.
Hi, I'm Drew Weilage. 