Rethinking Health Care: “People, Process, and Technology”

The Harvard Business Review is running a three week long series called Innovations in Health Care that is worth turning your attention toward. In today’s post, Jim Champy argues that government led health care reform will not be effective unless care givers radically rethink the health care delivery process.

When I first suggested to a team of health care clinicians that their work needed to be radically redesigned, I was told that the word “radical” was reserved for only the most serious of medical procedures and I had no license to use the word — after all, I was not even a physician. Today, I believe more than ever that only the radical redesign of health care’s clinical and administrative processes will deliver lower costs and improved safety.

What we describe as a “health care system” is no system at all. It’s a collection of fragmented, non-communicating parts, implicitly dangerous in design. During an average four day hospital stay, a patient sees 24 different clinicians and administrators; when a physician places an order for medications in a hospital, there are seventeen steps between when that order is given and when the medication reaches the patient’s bedside – all opportunities for error. And this complexity happens within a single health care delivery organization. When multiple physicians, clinics, hospitals – and insurance companies – are involved in the care of a patient, the complexity can be overwhelming, both for the patient and clinicians.

Designing a real system of care will require a combination of technology, process, and people. Information technology will be the great enabler of change – connecting multiple care givers, providing a portable health care record, and eventually providing the information required to link treatments to outcomes. But technology alone will not deliver lower costs and safer care. Clinical work must also change, and that involves process. We have seen great advances in the diagnosis and treatment of illness, but many of the processes in care delivery haven’t changed very much in fifty years – the same patient questions get repeatedly asked, delays exist in getting test results back, real patient education is left up to the patient and the Internet. And when information technology has been introduced into the physician’s examining room without process change, the work of physicians has become more difficult, not less. When work does change for the better, it’s also because the behaviors of people have changed – both clinicians and patients.

While the pin-heads in the Republican party go about attempting to dismantle/repeal The Affordable Health Care Act, the problems with the American health care system are only getting worse. It is nice to see that HBR is taking a “radical” approach to the idea by inviting people to explore all possibilities for change. I suggest our politicians pay attention to this little project, it just might open some eyes.

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