Honestly. Why do patients and physicians allow this nonsense to happen? One hopes that calm, rational, educated and caring people can make health care better through a slow adaptive process. At times however it does seem as if a patient-physician led coup will be necessary. It’s difficult to understand if the non-provider leaders in health care just don’t understand the human aspect of health care or if they don’t want to understand the human aspect of health care because it would expose how unimportant they really are to success if quality is the priority.
The goal of health care providers is to interact with other human beings to improve their health. The goal of health care administrators is to make numbers work. Health care administrators shuffle money, objects and people so that everything looks good on paper. More often than not the goal of the provider and the goal of the administrator are at odds.
A real-life example from a newly created health care system created by the blend of provider and payer with the intent of building an integrated delivery system that will compete in the anticipated future of health care where there is a focus on value, quality and cost. The new system has to date been mostly led by the payer. All decisions to date made by people whose job it is to make things look good on paper. And their answer for everything seems to be to create and manage templates. There is probably no greater example of the philosophical chasm between provider and administrator than the concept of templates. Templates completely remove the variability of the human interactions in health care. Human interactions are the essence of health care. Human interactions are also notoriously difficult to measure and manage.
One example of template-mania involves physician scheduling. The newly created health care system will be creating a centralized call center for scheduling. This is staffed by entry-level administrative types who will insert callers into a master data base of physician schedules. The goal of this initiative was to assure patients timely access to physicians and this was discussed in a previous post (“Fixing the Four Ring Problem. Driving Uniformity and Mediocrity”). Timely access over quality and experience? Timely access is an important, but not the most important, component of quality care. There are already bad examples of this template-driven and centralized scheduling system. Patients arriving at physician office without the necessary prior studies requiring a second visit. Patients getting put onto a resident-run clinic. Patients calling for a specific surgeon for a specific procedure and being told the surgeon does not do the procedure when in fact he/she does.
They love to template space as well. To an administrator an office is a small tin can into which you should fit as many sardines as possible. The noise and disruption are not important. It looks good on paper. Could they do their job as well if they shared the space. The clinical spaces are where the revenue is generated. In reality shouldn’t all the administrators be compressed into cubicles in a room that takes the least amount of space away from patient care?
Do we really need more high-priced VP’s in health care whose only skill is to manage a template of time or space? You honestly can’t manage health care with templates and expect quality health care and a great patient experience. Let’s fire the template jockeys and hire more nurses.
When does the patient-provider coup begin?