Decisions and Org Structure LO5170

Anastasio, Jon (Jon.Anastasio@FMR.Com)
Fri, 26 Jan 1996 09:55 -0500 (EST)

Replying to LO5097 (and the whole thread) --

A few thoughts related to the health care issue. They obviously represent
my personal point of view, (I am asked to say that by our Webmaster).
[And... here on LO, all comments are assumed to be personal opinions, not
official views of one's organization. -Your Host...]

Hi, All --

David, Gray, and others I may have missed -- I'd like to jump into the
health care discussion:

On January 18, Gray wrote:

>What you say sounds all very well in principle, but I am not sure how it
>relates to the present where clinicians are unable to provide the care
>that patients need because they are constrained by regulations made by
>managed care organisations who do not know the patient.

>You also make assumptions about what clinicians can handle. Clinicians all
>around the world are making resources allocation decisions. They just need
>to be better understood and supported.
--------------------------

Despite the possibilities for structural changes and major process
improvements in health care organizations, the dialogue eventually returns
to the local issue that, for example, an MRI costs 10 to 50 times what a
flat X-Ray costs. There is something that just seems inappropriate about
the economic point of view telling the doctor when to do which one. IMHO,
a skilled clinician uses their intuition based on past experience and
knowledge of the patient. There is less room for intuition in rigidly
managed treatment options, and some of those intuitive decisions are life
savers. I think we all would support decisions being made at the clinical
interface when that interface is the operating table we are lying on.

I worry that, because of the critical nature and enormous size of the
problem, we will say that the "big guns" need to solve it, simply
dismissing the front line worker in health care as unrealistic and
unreliable where organizational effectiveness is concerned. I think we do
so at our peril, because they have knowledge critical to finding the best
ones. If front line manufacturing employees are the best source of
information on how to improve the processes they use, how can that not be
true of nurses, X-Ray technicians, and all the others?

When I ran the training function for a 400-bed acute care and rehab
facility, I found most health care professionals I worked with were very
clear about cost as an issue -- it was often one of the first things on
the minds of their patients. And to Gray's point back a ways on this
thread, many of them were enthusiastic participants in discussions about
quality, cost reduction, and what would now be called process improvement.
My experience with them and the staff I knew in other hospitals suggests
to me that the best source for information on improving patient care and
many hospital operations rests with the people who are at the interface
between the patient and the administration. The administration is rightly
concerned about issues like cost management, risk management, and
efficiency. Health care professionals are rightly concerned about the
person in the bed. There is a balance that must be maintained between
those two, and I think for that to happen everyone has to be part of the
conversation about how to improve the system.

--
"Anastasio, Jon" <Jon.Anastasio@FMR.Com>