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Healthcare's Biggest Problem Is...

...too much money.  Wait.  What?

Interesting opinion yesterday from the blogosphere, that healthcare's biggest problem is too much money.  Too many resources, leading to too many people, too much time spent deliberating and too few imperatives toward action.

That's why, in our best leisurely fashion, we approve capital budgets just once a year.  Miss the cycle and it's 'wait 'til next year.'  And that's OK; it's not like it's life & death or anything.

Making the cycle, especially in IT, means launching RFP processes lasting another year and pilot projects lasting one more.  And system-wide rollouts lasting two more...assuming everything goes as planned, which it seldom does.  (Can you count to five?)

That's why off-the-shelf solutions costing 'a little' are rejected in favor of customized (yet corporate-approved) offerings costing twice as much and taking thrice as long.

That's why $8.99 iPhone apps are pooh-poohed as "not serious" and "risky" while the entry-level price for "real" software seemingly starts at $250k, rising rapidly after that.  (Ask me sometime about Voxie vs. the IT geeks.)

That's why our systems for cancer care are confusing messes yet our answer is to add yet another layer of staffing and expense - "Nurse Navigators" they're called.  I guess we'll start on that whole cost reduction and process simplification thing sometime tomorrow. 

And so we have armies of bureaucrats and analysts and process sponsors, technicians, project managers, coordinators and specialists.  We need them all to churn the system...and still we think of ourselves as understaffed.

And thus committees proliferate, PowerPoint becomes the organization's lingua franca, and, typically, the "back of the house" systems (Finance, IT, HR) are far more modern than "front of the house," customer-facing offerings.  When did YOU start offering patients an on-line portal and how many revenue cycle systems came and went before the portal's go-live?

Take away that money, most of the people and all of the committees.  Remove the luxury of time.  What's left? A startup mentality where cheap is better than expensive and free is best of all.  Where costs avoided mean making payroll...or not.  Where new customers this afternoon are better than impressive forecasts two years out.  Where a bias to action always trumps endless discussion.

What's Out: big checks to license Microsoft's crappy software (oops, is my bias showing?)  What's In: free Google apps.

What's Out: elaborate performance monitoring and benchmarking systems.  What's in: free daily tracking from iDoneThis.

Money gives you the luxury of time and lessens the pressure of deliberation.  That's not always a good thing.  And it's why a million little, ankle-biting startups are about to eat hospitals for lunch.  I'm just sayin.'

UPDATE:  Don't believe me?  Read "What We Can Learn From Third-World Health Care" by Pauline W. Chen, M.D., writing in the New York Times:

"The key to their success is an unabashed disregard for some of our most cherished assumptions about what constitutes good care. Instead of providing antibiotics, CT scans and high-tech interventions, Partners in Health considers basic necessities like food and housing as critical components of the group’s medical work. Instead of asking patients to travel miles to the only clinic and see only the doctor or nurse, they train cadres of community health workers who can monitor, administer and advise in the heart of local villages and in people’s homes.
"Applied to organizations in the United States, this approach has proved startlingly effective, as the Prevention and Access to Care and Treatment, or PACT, program has demonstrated. PACT targets some of the poorest and sickest patients with H.I.V. and other chronic illnesses in the greater Boston area. Just like Partners in Health, PACT relies extensively on community health workers who are trained in tasks like helping patients take their medications and make it to clinic appointments as well as reviewing their pantries and teaching them to prepare healthy meals. Applying these broad definitions of care, PACT has significantly decreased the number of emergency room visits and life-threatening opportunistic infections, cut hospitalization rates by 60 percent and yielded a 16 percent savings for Medicaid."


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