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Is healthcare still local?

I have been a part of healthcare as an insurer or provider for 30+ years.  I learned a few axioms we all accept:

Healthcare is LOCAL.  Healthcare is unique, other industries’ lessons do not apply.  Doctors will only listen to other doctors.

Maybe it is time to take a hard look at these assumptions.

Evidence based medicine, CMS expectations that physicians will comply with “best practices”, standard treatment plans and order sets, published ranges for all manner of diagnostic parameters all illustrate the growing body of confidence that there is a “best way” to practice.  The focus has shifted to achieving consistently high adoption and application of the most current clinical practices for every patient in every locale.  Reduced variation in drug formularies, clinical supplies and medical equipment enable consistent clinical practice, robust training programs, performance metrics and, ultimately, improving patient safety and outcomes.

Checklists, timeouts, attention to “command doctor” culture and behavior are all initiatives initially researched and demonstrated in the commercial air industry.  The parallels are striking.  No pilot takes off or lands without having formally run their checklist.  There is always a pre-takeoff “timeout” to run up engines and verify control surface function.   Cockpits, like surgeries, historically had a clear “command structure” culture.  Many accident investigations reveal that crashes were preventable, avoidable or recoverable – if only other members of the crew spoke up, were respected and heard by the command pilot.  The antidote has been formal culture training and feedback to assure effective communication and focus, now a standard element of all commercial pilot training.  Many hospitals are beginning to adopt similar programs.  The impact on safety and outcomes is impressive, but not surprising.

Doctors are highly trained, encouraged to think independently and tend to practice individually.  When it comes to healthcare practice, they are the experts.  Increasingly, doctors are opting to practice as employees and not independent businessmen.  As employees, doctors are often challenged to accept leadership, feedback and direction from professionals that are smart, skilled, experienced, accountable for results and outcomes, but are not, themselves, clinicians.  Doctors are generally not experts at workflow, safety, supply chain management, revenue management and a host of other specialties required to support and sustain sound clinical practice.   Improvement in healthcare execution, operations, accessibility and outcomes are impaired or prevented when the competencies and contributions of everyone are not fully leveraged.

Independently practicing doctors are not “off the hook”.  While the doctor may be the quarterback, a physician’s reputation and outcomes are, ultimately, the product of teamwork.  Care teams typically do not work exclusively with one doctor.  In these cases, doctors should be expected to “join the team” not have the team adapt to the personal practices of each doctor on medical staff.  Only then can a care team adopt and become adept at sound clinical process and practice.

Measurement will, inevitably, serve to develop and identify most effective practices.  These practices should be adopted everywhere and by everyone.  If healthcare has been marked by subjective, individual or local decisions and practices, it is time to become objective, collective and consistent.  Only then can ineffective and inappropriate variations in local practice be replaced with sound practice, up to date and consistent with the most current science and practices.

Building a regional care system?  Supplying tools/service to disrupt healthcare?  Call today to engage BrightWork Advisory, LLC in a strategic review.

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