A real healthcare redesign
By Thomas Day
I read a very good article in the Harvard Business Review the other day, titled “Fixing Health Care on the Front Lines,” by Richard M. J. Bohmer. (While I’m not a frequent reader of HBR, a friend and former HMC’er sent it to me.) We hear lots of talk about “redesigning” healthcare, but until now, it has all sounded a little vague, very global, ill-defined, and often politically motivated to me. However, Bohmer puts together some very interesting frameworks for what a redesign actually means to providers and how to proceed.
Let me highlight some of the key insights I pulled away from the article. The very best one was the top level assessment, where he states health care providers must “excel at performing three discrete tasks simultaneously.” These tasks are:
*Rigorously applying scientifically established best practices for diagnosing and treating diseases that are well understood.
*Using a trial-and-error process to deal with conditions that are complicated or poorly understood.
* Capturing and applying the knowledge generated by day-to-day care.
Doesn’t this get at the core of the issue? Not every disease and patient requires Sherlock Holmes-levels of detective work, and these cases should be handled differently than those that are more confounding, variable, and complicated. Additionally, Bohmer notes that “more than a quarter of Americans over 65 suffer from four or more interacting diseases.” These sorts of complicated patients need different treatment processes and methods, “corralling their variability” from the more predictable patient cases.
Finally, he insightfully observes that medical knowledge comes from more than research and scientists. Rather, it comes from all directions in the daily practice of medicine. The consequence of this is far reaching – but it’s an open question about how you capture individual caregiver knowledge, synthesize it, and distribute it for use to all other caregivers.
Bohmer also offers excellent eye-opening examples, citing how “Intermountain has protocols on roughly 70 conditions that make up more than 90 percent of the caseload.” He notes how a “hospital in a hospital” can separate cases benefiting from a tight protocol from those that require careful and ongoing diagnosis, treatment, and monitoring.
All in all, this article is a real mind-bender.
Thomas Day is president of HMC.
