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Fixing healthcare requires Netflix-like disruption

Brian Eastwood | Dec. 10, 2013
There's no shortage of ideas about how to fix what the Institute of Medicine deemed the quality chasm back in 2001. However initiatives taken so far aren't yet working.

Healthcare's bubble stems from an industry with too many hospital beds, too many machines doing too many unnecessary tests, and too many specialists earning too much money and enjoying too much influence, Brenner says. There's isn't a shortage of doctors, he continues, but, rather, too many.

As Brenner sees it, healthcare needs half as many doctors, twice as many nurses and three times as many health coaches. Rushika Fernandopulle, co-founder and CEO of Iora Health, agrees.

Iora Health, with practices in four states, emphasizes the importance of team-based care. Each day begins with a practice-wide huddle; a doctor may lead one day, the secretary the next. There are no offices or "reserved" parking spaces. Practices have up to four times as many health coaches as physicians. Empathy drives decisions; physicians, nurses and caregivers are essentially asked to treat each patient like their own mother, Fernandopulle says.

Why do we need a dramatically different approach to healthcare? As Fernandopulle put it, you don't build an airplane by putting wings on a ship. You build an airplane."

Empowered Healthcare Employees Make Better Decisions
Such an approach isn't limited to small practices. Kaiser Permanente, an integrated delivery network that operates in nine states, has been regarded as an agent of change for 70 years, says John August, associate director of the Healthcare Transformation Project at Cornell University Institute of Labor Relations. (August previously served as Executive Director of the Coalition of Kaiser Permanente Unions.)

Such an approach isn't limited to small practices. Kaiser Permanente, an integrated delivery network that operates in nine states, has been regarded as an agent of change for 70 years, says John August, associate director of the Healthcare Transformation Project at Cornell University Institute of Labor Relations. (August previously served as Executive Director of the Coalition of Kaiser Permanente Unions.)

Faced with the threat of strikes in the early 1990s, Kaiser responded by creating a labor-management partnership through which employees help determine performance-based outcomes. Such empowerment convinces employees that they are, in fact, part of the solution, August says. Once such solution: The proactive office encounter, in which a receptionist analyzes patients' records while they wait for an appointment and schedules them for preventive screenings they would otherwise miss.

The process is admittedly one filled with fear and failure, August says - understandably, some receptionists were reluctant to tell unknowing patients they needed cancer screenings. That's all the more reason to make sure everyone in the office goes through the disruptive process together.

Every Bill for Hospitalization 'Cost of Missed Opportunity' to Do Better
It is, indeed, a disruptive process. Healthcare today approaches each office visit with what Brenner calls a "one-size-fits-all hammer" - whether an office visit is an annual physical or a post-operation follow-up, it's unlikely to last more than 15 minutes. Clearly, this doesn't serve patient's needs.

 

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