Jon:
Great post and - having spent many years in healthcare as a process
changer - I agree totally with your conclusions about healthcare workers.
They are very aware of cost as an issue and of the quality of care. I
think several things make it difficult for those workers and their
institutions to beter grapple with the issue:
- Still trapped in the cost vs. quality paradigm when most other
industries have found that they can improve both.
- The deeply embedded, often legally enforced - silo structure of
healthcare organizations
- Failure to truly understand the system and its cost structure. Few in
heathcare understand activity based costing or queueing factors, the
industry still wallows in 'traditional' cost accounting systems that
obscure meaningful cost improvements that would not reduce quality. For
example, one hospital I know fought with its major payors for years about
exercise tolerance testing on the weekends until that providor threatened
to stop paying for the patient's prolonged stay caused by the ETT
bottleneck. The hospital instituted weekend testing and reduced LOS.
Goldratt's theory of constraints has not yet migrated fully into
healthcare.
- The hierarchical nature of hospitals, where 'policy' and budgets are the
purview of senior leadership. Or worse, backroom 'case managers' at the
payors.
- Fuzziness and ambiguity in outcomes measurements. Unfortunately, human
beings are complex systems andare more difficult to measure than less
sentient products. This makes determining cost-effectiveness moredifficult
than it perhaps is in other industries.
- Lackof true empowerment, as we have discussed it on this list.
- Lack of tools at the bedside to help coordinate and manage increasingly
complex care processes. Process management and communication lags
seriously behind other industries. Ever notice how much of the paperwork -
and the questions you're asked - are redundant?
I'll stop here. I am chewing up too much bandwidth with this already.
Regards,
-- //////////////////////////////////////////////////////////////// Bob Luttman Principal Robert Luttman & Associates * 50 Keith Street * West Roxbury, MA 02132 Phone/Fax: 617.327.6253 * email: rluttman@zork.tiac.net * Web: www.tiac.net/users/rluttman/RLA.html Process Improvement Consulting to the Healthcare Industry