“The Business of Medicine” sounds like a contradiction in terminology. A great profession, an honorable vocation, a renunciation of self for others.now the profession is so reduced
of Widget Maker. It is carried out in a system called “RVU” or Relative Value Units. This is an archaic system based on diagnostics as well as volume. Despite all our efforts, the United States continues to fail in healthcare delivery and outcomes.
If healthcare is run like a business, let patients truly come first. Of course, this comes first. From a business and human perspective, we must never forget this. That said, learn from business discipline, both from successes and from failures.
A suitable model to use is taken from Dr. W. Edwards Deming’s paper on “The Five Deadly Diseases 1984”. Deming was a post-World War II American statistician who helped lift Japan from the ravages of war and create the economic powerhouse it is today.
This article takes each of his claims and compares them to today’s medical business practices. This comparison is not related to any particular hospital, insurance company, or healthcare system, but to healthcare as a whole.
1. Lack of consistency of purpose: Deming refers to planning production and services so that you can always look forward and push decisions to those who know best about the issues at hand. Innovation, research and education, and design improvement are key points here. How does this relate specifically to medicine? We remain short-sighted. For example, insurance companies may pay for certain expensive treatments, but less on prevention. This has improved to some extent, but it’s certainly still lightyears away. As one of the many examples, we still struggle to obtain medications for smoking cessation. Providers should work with the highest level of education and should not spend most of their time at a desk or computer. The Medical Economics article referenced below estimates that a healthcare provider spends 49% of her time on her EHR and desk work, and only 27% of her time on patient face-to-face care. Another issue worth mentioning is education. Education is often overlooked in RVU systems. There is a push to production, aiming for higher production levels. This comes at the expense of time spent with patients, peer-to-peer interaction and, frankly, education in general. even cause suicide, as statistics show.
2. Immediate profit emphasis, immediate thinking. Fear of “losing” or a brusque takeover. Health systems often base their revenues and successes on quarterly data, but the reality can be at the expense of the future of health care providers, the communities they serve, and entire institutions. I have. They can overreach, overspend, or overemphasize the wrong short-term goals and lose sight of how these decisions affect us all in the future. The system has acquired other practices and other health-related businesses to further expand its reach. There seems to be a fear of affiliating with other entities. “We need to look good”. beat the competition. Conquer the best and brightest to defend your position. Take advantage of harsh non-compete agreements that can keep healthcare providers out of the communities they serve. There is an overwhelming sense of control and essentially provider ownership. This affects morale and causes a loss of talent from the community, often with the greatest impact on patients and practitioners. These can be used not only by the people who need these services, but also by the systems themselves, a huge loss for all stakeholders.
3. Merit Rating or Annual Review. Sounds reasonable, right? But as Deming said, “Pay for what you get. Get what you pay for. It motivates people to do what is best for their own good. The effect is , quite the opposite of what the words promise: “Part of the argument is that perhaps 90% or more of performance in a professional healthcare setting is a result of interactions with colleagues, the people around them, and the very system in which they work. What Deming suggests here is that real improvement should focus on systems, processes, and methods, not individuals. In our opinion, focusing on the individual was a low-yielding strategy: rather than asking the “why,” focus on the “who.” “Who” didn’t clean up the spill outside the collection room, not “why” it wasn’t cleaned up and made safe. This concept is admittedly a bit difficult to swallow, but I feel that many of us can really see value from this perspective, taking a step back from our ingrained cultures and ways of doing things.
4. Management mobility. This theory opposes rapid turnover of management. Managers often jump from position to position within an organization without fully understanding the entire system. Metrics are created to show the manager’s success, not to create a metric that benefits the organization. One interesting observation is that in Japan, an industrial powerhouse in a very small country, upon leaving school, individuals go to factory floors, work on assembly lines, ship products, and spend years and eventually move to a higher management position. This builds a complex working knowledge, buy-in and sense of belonging about the company. This person understands the culture perfectly, is able to observe and learn from past failures and successes, and earns the respect of his colleagues. Many CEOs of large companies, on average, he stays only four years. They may be engaged in “building an empire”, or taking on a project that ultimately has a negative present value, setting artificial success and allowing them to move to a higher position in another company. While these projects may look good at first glance, the amount of these entities under the company’s control increases and can ultimately lead to failure. “It was going pretty well when I left”. Unfortunately, these scenarios occur frequently in healthcare systems.
5. Manage only visible numbers, with little or no consideration for unknown or unknowable numbers. It sounds confusing outside the gate, but what is really meant here?
Measuring data alone is not enough for what it takes to make healthcare as a business successful. Many things that affect the system cannot be simply quantified, but still need to be accounted for. How do unhappy patients affect the healthcare system? What about disgruntled providers?
These are very important aspects to consider in the healthcare business and should be accounted for, even if they are difficult or nearly impossible to measure.
These issues can certainly paint a pretty bleak picture, but all is not lost. First, we have to agree that the problem exists. I’m sure most people can agree on this point. Then we have to work on fixing the “deadly disease”. For the good of business, we call health care, for our communities and most importantly for our patients. points are only a small part of what he has offered) can certainly serve as a springboard for change.
Vincent A. Cantone, MD, FAAP, FACP is a physician and pediatrician currently pursuing an MBA through the Johns Hopkins Carey School of Business.
References:
1. Anderson, P. (May 8, 2018) Doctors have the highest suicide rate of any profession. https://www.webmd.com/mental-health/news/20180508/doctors-suicide-rate-highest-of-any-profession
2. Bendix, J. (April 2022) Destroying Busy Work. Health Economics,99(4),22-25
3. W. Edwards Deming Institute. (nd) The Seven Deadly Diseases of Management. https://deming.org/explore/seven-deadly-diseases/
4. W. Edwards Deming Institute. (September 21, 2015) Create a desired consistency.
5. W. Edwards Deming Institute. (January 9, 2017). Deadly diseases of management: Emphasis on short-term gains.
Deadly Disease of Management: Emphasis on Short-term Profits
6. W. Edwards Deming Institute. (October 29, 2012).Dr. Deming called for the abolition of annual performance reviews
Dr. Deming Called for the Elimination of The Annual Performance Appraisal
7. W. Edwards Deming Institute. (July 15, 2013).Management mobility
8. W. Edwards Deming Institute. (13 August 2015). Myth: If you can’t measure it, you can’t manage it.
9. (Dr. W. Edwards Deming-Guest). (Producer of Chuck Olin Associates, Inc, Chicago). (1984) Dr. Deming – Five Fatal Diseases.encyclopedia britannica movies
.
Comments
Post a Comment