Where is the waste in health care?

More and more hospitals are realizing that the 30 to 50 percent of waste occurring within their organizations is not only real, but a tremendous opportunity.  This is good news for both our patients and our health care system.  The bad news is that many hospital executives believe that this waste is largely limited to processes like materials management, ER wait times and operating room first-starts.

The next step in our health care cultural awakening is to recognize the tremendous amount of waste that occurs every day when we actually take care of patients.  This is much more difficult to grasp for both hospital executives and physicians.

For many executives, a big challenge lies in their lack of understanding of clinical processes.  It has been a gradual evolution to go from top-down cost reduction strategies like sweeping layoffs and reorganizing support services to concentrating more on inefficient processes like streamlining operating room turnover time.  Focusing on improving clinical care processes is far more difficult for them to comprehend.

First of all, many of today’s hospital executives have no clinical background.  Secondly, any practicing physician knows that the decades-old divide between the craft of medicine and the craft of administration is very real.  This divide makes true collaboration difficult.

Challenges in managing clinical care also exist for physicians.  These challenges start with a lack of understanding that there is even an issue to be managed.  Let’s face it, we weren’t taught to think like that in medical school.  The vast majority of us were trained in the crafts-style method of health care delivery where we each practice autonomously, creating the perfect care plan for each patient.  Our care plan may differ from our peers nationally, regionally, or even within our own practice group.  Moreover, the way we personally manage the same disease may vary unnecessarily from day to day.

One physician may order significantly more diagnostic tests than another, or prescribe a more expensive drug that has no added clinical benefit.  Another may have longer lengths of stay or higher complication rates.  All of these factors contribute to significant variation in cost and quality of patient care.

If everyone in your group manages a given disease differently, it’s simply not possible that you’re all doing it the best way.

That doesn’t mean you’re doing something wrong, you’re just maybe not providing the best care possible.  Isn’t it to everyone’s advantage (yours and your patients’) to start a dialog about how to refine clinical care processes for the better?  How do you know where to start when everyone is doing things differently, and you can’t track actual patient outcomes?

Taking control of the waste in clinical care processes puts physicians back in control of spiraling health care costs and less than ideal clinical outcomes.  Only we hold the expertise to determine what the best care is for our patients.

Alexandra S. Brown is associate director, Healthcare Delivery Institute, HORNE LLP.

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