Bringing Together the Stakeholders in Medicine
Do You Get It? We Need You!
Major corporate efforts in the US to bring us better health have almost universally failed. Singapore has a much better health system at one fourth the impact on gross domestic product (GDP). We spend one dollar out of every five on health care. They spend one dollar out of every twenty of their GDP on healthcare. As I have written in the last three posts, our corporate efforts have failed for several reasons, but the most important is their failure to follow the blueprint from the National Academy of Medicine (NAM), formerly known as the Institute of Medicine (IOM).
Between the next generation primary care clinical teams and the health care environment lie many health care organizations, including hospitals, health insurance companies, medical groups, multispeciality clinics, and large hospital systems. In our system these efforts are all highly fragmented. No one of these stakeholders has systems and finances that are transparent to the other stakeholders. Leaders of today's health care organizations face a huge challenge in redesigning their organization and delivery of care to meet the needs of patients with chronic diseases. It is especially difficult when one is trying to change routine processes and procedures in these stakeholder operations to alter how people conduct their everyday work, individually and collectively. No one stakeholder, even one as massive as Walmart, can successfully change our massive entrenched system of stakeholders. And you will wear yourself our trying to convince many of the current stakeholders to change what they are doing. That is why the keystone to progress is identifying stakeholders that “get it.” It is critical to identify other stakeholders that understand the need for change and collaborate with them. Most of these will not be the winners under the current system. They view change as a threat to their influence and power. Progress will most likely come from new players that understand the roadmap from the National Academy and are willing to collaborate to develop a new system for chronic disease management. The old system won’t change. Twenty years of experience have proven that. A new system must lead them.
The link above takes you to a description of what is needed and then offers a set of tools and systems, drawing heavily from engineering concepts, as a guide for care redesign. Another section in Crossing the Quality Chasm offered a set of rules that would redesign the nature of interactions between a clinician and a patient to improve the quality of care. This section describes how your organization can redesign care to systematically improve the quality of care for patients. Here are some techniques used in other industries that may be useful in healthcare.
All health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.
“That clinicians and patients, and the health care organizations that support care delivery, adopt a new set of principles to guide the redesign of care processes.
That the Department of Health and Human Services identify a set of priority conditions upon which to focus initial efforts, provide resources to stimulate innovation, and initiate the change process.
That health care organizations design and implement more effective organizational support processes to make change in the delivery of care possible.
That purchasers, regulators, health professions, educational institutions, and the Department of Health and Human Services create an environment that fosters and rewards improvement by (1) creating an infrastructure to support evidence-based practice, (2) facilitating the use of information technology, (3) aligning payment incentives, and (4) preparing the workforce to better serve patients in a world of expanding knowledge and rapid change.”
This blueprint for change comes from the National Academy of medicine which is part of the National Academy of Sciences (NAS) which is a private, non-profit society of distinguished leaders in science. “Established by an Act of Congress, signed by President Abraham Lincoln in 1863, the NAS is charged with providing independent, objective advice to the nation on matters related to science and technology. Scientists are elected by their peers to membership in the NAS for outstanding contributions to research…. Approximately 500 current and deceased members of the NAS have won a Nobel Prize.” Clearly these are the best and the brightest.
Here is the problem. Crossing the Quality Chasm was written over 20 years ago and nothing has changed. Our healthcare system is as broken as ever, and it still does a terrible job with patients who have chronic disease. Our system produces poor outcomes at very high cost. Leaders in government and medicine have ignored the blueprint but we have proven that the blueprint works. I write about this topic on this site consistently. The government and current medical leaders have shown they will not do what they must do to improve the health of Americans and reduce the cost of care. If you are a stakeholder who gets it, get in touch with us. We need every one of your to achieve success.