by Marya Zilberberg, MD, MPH
When we talk about efficiency in the business world, we are basically talking about getting as much profit as possible. This profit is wrung out of the system by reducing production costs to the maximum extent possible and by charging the top price that the market allows.
Some of the ways in which the US companies have increased their efficiencies over the last 30 years are, 1) by moving manufacturing to developing nations, where labor is extremely cheap; 2) by reducing the US workforce to the bare minimum through increased use of automation (and don’t we all look forward to talking to a computer when we are looking for customer service on the phone!); and, 3) keeping down the US workers’ wages at their 1975 levels, even as the productivity has grown exponentially.
So, now I come to my concerns about healthcare. Efficiency is one of the domains identified originally in the Institute of Medicine’s report “Crossing the Quality Chasm” as a measure of a functional healthcare system. Since then, the Commonwealth Fund has consistently given a poor grade for efficiency in their annual report card. And there is no question that the system as it stands today breeds inefficiency.
On the other hand, I worry that in our traditional American single-minded zeal we will go overboard on efficiency in healthcare purely in the business sense. The Six Sigma models and similar lean techniques are designed for the world of business. Medicine, I would argue, is a densely cognitive field, and despite the illusion that computerization will obviate the need for human attention, we should always demand that a human being, not a computer, is thinking about our medical picture in a holistic way in our hour of need.
So, while we really do need to get rid of the considerable amount of blubber in the system as it exists today, we should never tolerate the adoption of the the traditional business view of efficiency. We must be vigilant against reproducing the curve above in our healthcare system. And as much as health IT is seen as the holy grail of medicine, let us not work under the woeful misapprehension that this valuable and necessary tool can replace medicine’s practitioners, who spend their careers cultivating the art of medicine, as well as the science.
And if you do not believe that there is art to medicine, you have never had a serious encounter with it either as a clinician or as a patient.
Marya Zilberberg is founder and CEO of EviMed Research Group and blogs at Healthcare, etc.
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{ 6 comments }
Outsourcing is alive and well in medicine. Radiology reports for hospitals in the US are read in Australia and India. Medical tourism to Latin America, Thailand, South Africa, etc is on the rise. The so-called “Healthcare Reform” currently being debated in DC may cause many American physicians to outsource themselves.
In my experience the physicians and medical practices most focused on increasing efficiencies are those with business owners, even if those include physicians. Cosmetic medical practices are a examples. Since there’s no third party payers or ‘code games’, inefficiencies bubble immediately to the surface since the practices are small and dollars are felt immediately.
To allow inefficiencies to continue is to allow yourself to go out of business. This will be a growing trend in medicine. Indeed, it is already happening with the increasing presence of EHR. If it matters, it’s measured, and believe me, with EHR it is measured. The first step in cost-cutting, with many more to follow.
While I agree with your thoughts for the most part, I still think that efficiency, or at least the act of optimization, creates competition and therefore can potentially create a better health care environment…although that is of course not always the case.
Before we worry about the dangers of adopting business efficiencies in medicine we should at least get to the point where we are able to say we have rung out all the inefficiencies. We are leaps and bounds from that point.
I am part of a leadership team that involves caring for 300K patients per year in emergency departments in the DC metro area. I work clinically for 40-50% of my time per month in addition to my leadership responsibilities. In medicine it is rare that clinicians get individual feedback on performance including quality of care and efficiency of practice, even in larger groups. This is witnessed by the many good people who join our organization and have never had ANY type of feedback after residency. While there is much that is cognitive about medicine there is also much of it that is routine especially in the area of managing chronic disease and routine ED care.
I believe we have much to learn from business and the efficiencies it has developed over time. How to do that and maintain our compassion for individual patients will always be a challenge. In the end we must find that balance for the benefit of our patients and ourselves as the current system can not support the overall escalation in costs in perpetuity.
IN THE WRONG ‘THINKING LANE’
Efficiency is not the word. “Outcomes” is more relevant.
That is: is your patient-group being treated with maximal quality, professionalism — and efficiency.
Few mistakes? Well-read on professional journals? Treating patients at a safe, brisk pace? No excessive charges?
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