The health care system in the U.S. is in the process of change. While it took the economic reality to drive change the system can also be described as dysfunctional in many dimensions. Hopefully we can finally get this right. Any meaningful improvement in health care will require the involved stakeholders (patients, providers and payers) to completely disconnect from the current disastrous steady state. The changes need to be as deep as they are wide. The Institute of Medicine recently published “Best Care at Lower Cost. The Path to Continuously Learning Health Care in America.” The authors note that professionals in health care are “overwhelmed” by initiatives to improve care and that any initiative that focuses on incremental improvement and adds to a clinician’s daily work load are unlikely to succeed. The expert authors suggest transformational change. We need to transform health care beginning with a foundation that focuses first and foremost on the relationship between a patient in need of health care services and the professional who provides those services. It needs to be a ground up, not top down, restructuring.
At a recent meeting of an organization that is in the process of assembling an integrated delivery system a leader mentioned that he was receiving calls from around the country to see how he is going to do it. Those in leadership positions at other organizations are aware that change is inevitable and want to learn from the brave in the front of the line. If the plan is simply to improve operating margins by 5% via aggressive pursuit of efficiencies the calls will stop and the callers will look elsewhere. They are looking for innovations.
When something has been so bad and dysfunctional for so long you could argue that it is even beyond a transformation. It may be best to just CTRL-ALT-DEL health care and start over fresh with a new vision. Thus, it may be advantageous to be building something new.
Health care now needs leaders who have: (1) the heart to acknowledge that this is a service that a civilized society can and should provide to all citizens at some basic level, (2) the brains to devise a new system, and (3) the courage to implement the new changes in the face of multiple special interest groups that have only self-serving interests.