Healthcare Reform: Delivering Best Care at Lower Cost

Writing in the September 10th issue of The Atlantic, physician Richard Gunderman took issue with the Institute of Medicine for using the word “industry” to describe healthcare in its recent study on waste in the system, titled “Best Care at Lower Cost.”

His blog article, “The Fallacy of Treating Health Care as an Industry,” is a very real example of the complex challenges and multiple opinions of what it takes to deliver the best healthcare at the lowest cost in America. Dr. Gunderman challenges the IOM’s assertion that one third of U.S. annual healthcare spending — $750 billion – is “wasted.” He also disagrees with the study’s conclusion that much of this waste can be eliminated by adopting practices from other industries.

 

It’s interesting to hear the clinician’s side of the argument. Gunderman takes issue with “waste” and regulations that may impede his judgment in how to care for his patients. He’s arguing that the “what” of medicine can’t (or shouldn’t) be regulated or engineered. But, there’s also the “how” of care delivery that most certainly can benefit from examples from commercial industries.

“For one thing,” Dr. Gunderman writes, “the practice of medicine is not primarily an economic activity and measuring its inputs and outputs in dollars and cents provides a narrow and superficial view of what really goes on in doctors’ offices and hospitals.”

“If we evaluate medical practice solely by whether or not physicians are following clinical pathways favored by industrial analysis,” he writes, “we will omit more than we capture about how physicians care for their patients.”

The IOM study used several examples from commercial industries which might be guideposts for streamlining operations and eliminating medical errors. Gunderman interprets that as a blueprint for a “Frankenstein monstrosity.” “We cannot merely mix up two-thirds of a cup of banking, a quarter cup of manufacturing, and two tablespoons of airline policies and procedures and expect to produce well-integrated patient care,” he says.

While acknowledging that “contemporary healthcare is more expensive than it needs to be” and that “industrial experts may have important contributions to make in this regard,” Gunderman cautions that “we must never allow the relationships between health professionals and their patients to be completely subsumed under rubric of ‘a health care industry’.”

That single word – INDUSTRY – causes enough friction that it can cloud the process of re-engineering those aspects of healthcare which can benefit from outside expertise – namely, the operational side.

Gunderman’s fundamental points are that medicine is about more than delivering tests and medicines as efficiently as possible and that time spent between doctor and patient is not wasted.

We acknowledge that both are true, but in the meantime, why not deliver the tests, the medicines and the patients as efficiently as possible? There is plenty of wasted time to cut in healthcare without cutting the time normally spent between a doctor and a patient. In fact, when “engineered” correctly, efficient operations can actually increase that valuable time between clinicians and patients:

Part of what patients suffer is extended time in waiting rooms and hospital beds because the existing throughput process is “a broken down mechanism.” This is especially true in large, complex hospital environments where dozens of staff, hundreds of rooms, a multitude of equipment and numerous operational processes are required to get patients quickly and safely from point A to point B.
“Patchwork” best describes the way workflow processes, including patient throughput, have evolved over the years since the concept of hospitals was first developed. As one renowned industrial efficiency expert said, “Talking about re-engineering healthcare assumes that it was engineered in the first place.”
It seems that the IOM study was suggesting that healthcare adopt the best of what industry has to offer and leave the rest, including the assembly line. If more medical professionals could get past the industry comparison and “peer deeply” into what advanced healthcare IT has to offer on the operational side of care delivery, I’m convinced they’ll find that it actually helps them in their mission to deliver better care to their patients.