This week I’m writing about the search for the Holy Grail of the new healthcare market … integrated delivery systems (IDSs) such as ours must now lower the cost of a unit of care, while simultaneously improving patient outcomes. This is to be differentiated from the soon-to-be old IDS model in which lowering the number of units (e.g., fewer hospital days needed for a population of patients) paid for the higher cost of an office visit (the cost of systems of integration [e.g., KP HealthConnect], space and personnel). I know what you’re thinking … Which Holy Grail are we talking about here?
But consider this … if we believe our current healthcare operations, efficient as they no doubt are, still have imperfect processes, redundancy of activity, clinician-brain use <100%, inadequate enlistment of patient effort, and inconsistent pairing of physician and nursing staff, then in fact it is possible to further reduce waste and thus cut costs for members. So, imagine a future day in which …
(1) every member of the healthcare team practiced at his/her maximal scope of practice, all the time: surgeons spent more of their time operating; physicians spent more of their time doing diagnostic and therapeutic analysis for individual patients and populations of members (and doing no nursing work); RNs did more patient education and care coordination; LPNs did no MA work … you get the idea.
(2) better match patient demand with clinician supply: all personnel needed for a specific office visit for a specific patient were present 100% of the time, and never present when not needed.
(3) more effectively use each physical asset we have: space costs lost of money to create, maintain, heat and light. Is every exam room we now own enhancing the health of our members in that area?
(4) more thoroughly motivate the patient / member to act on their behalf; the next billion dollar drug / procedure will be that which changes patient behavior in ways she / he finds specifically beneficial to their health, rather than adherent to prescribed healthcare.
If we could do all four, reliably, we’d solve more patient problems in less time at less cost compared with today’s operational design. The age of the EMR has a tendency to lower team productivity in unexpected ways – workflows designed to accommodate the latest EMR functionality defaulted to the physician doing more work, even though that new work was below her/his scope of practice, rather than doing the hard engineering work to distribute the new work to the most appropriate member of the team.
The historical difficulty of designing such maximally efficient clinical operations has been due to: (1) our profession’s insufficient ability to anticipate all of the patient’s needs at a future location and time – a manifestation of American healthcare’s decades of reactive care, rather than proactive care, (2) fighting against, rather than planning for, the inherent complexity of the human condition, and (3) our insufficient flexibility in operations to respond to those predictions and uncertainties.
But we should not assume it can never be done; we simply haven’t done it yet. In the third segment of this series, I’ll take a stab at The How … how we execute upon those four goals by redesigning operations in a manner that is more accommodating, effective and less costly – indeed, less reliant on capital-intensive healthcare, like space and people (see Of Castles and Trebuchets).
Click here to read the next post in the series, “In Search of the Holy Grail – the How”