Decisions and Org Structure LO5019 - And health reforms

Bob Luttman (rluttman@zork.tiac.net)
Sun, 21 Jan 1996 16:39:52 -0500

Replying to LO4913 --

Gray wrote:

>Yes, there have been problems. But how can you argue that decisions can be
>removed from the clinical interface when so much of the understanding of
>the nature of the problem, the character and needs of the patient, and the
>technical expertise is right there at the clinical interface.
>
>By removing decisionmaking from the clinical interface, you are making the
>basic Taylorist mistake by saying that workers can't understand the
>economic issues, so must be dictated to. You also lead to bureaucratic
>medicine.
>
>Maybe it would be better to look at training, and ways in which economic
>decisions can be factored into the clinical interface, rather than
>removing decisions from the interface.
>
>Why do we talk so much about empowering workers, and so gladly disempower
>clinical workers?
>
>Gray Southon

I must agree with Gray, much of the trouble in healthcare comes from
removing decision making from the bedside and the lack of real teamwork
amongst the care team. Healthcare is so hierarcical and 'divisionalized'
that learning is disabled. What we need to do is have better learning
organizations in healthcare starting with the care team and working upward
and outward through the organization and across disciplines.

I also agree that we need to find a better way to get economic decision
making into clinical decision making. I have worked on and with
rudimentary systems for doing as part of a computerized order entry
system. Clinical epidemiology also has some potential as does outcomes
measurement. The problem is that outcomes measurement is problematic and
this makes cost-benefit analysis murky.

We also, like much of industry, do not have good cost accounting systems
so our economic analysis is often muddled.

'Nuff for now.

--
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 Bob Luttman
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