Health care is at a cross roads. \u00a0Are physicians the problem or the solution? \u00a0I’m not sure how much of the problem they are, but I’m certain they are part of the solution. \u00a0Physician behavior is the result of the system within which they work.<\/p>\n
Truthfully physicians are the \u201csmart cogs\u201d of health care. \u00a0And we need to design a system that optimally leverages this strength. \u00a0Deming referred to those front line workers who most understand the processes as the smart cogs. \u00a0\u00a0In health care smart cogs serve two purposes: 1) applying, adjusting and adapting standard processes to individual patients, and 2) leading the creation and continuous improvement of those standard processes.<\/p>\n
However, our system of health care hasn’t empowered or enabled physicians to be effective smart cogs. \u00a0 First, the fee for service model has driven the idea that every thing must be related to the generation of RVUs.\u00a0 Thus, physicians don\u2019t have the time to do job #2 of the smart cog, and they spend less time doing job #1 simply because it takes time.\u00a0 Second, the capacity for physician to\u00a0understand the processes of care is decreasing.\u00a0 With increasing complexity, even the smartest physicians are finding it hard to be experts in care delivery.\u00a0 Third, applying the science of quality improvement generates data, and that data needs to be analyzed, which takes time as well as expert knowledge of the science of improvement.\u00a0 Physicians lack the time and often the skills.\u00a0 \u00a0Fourth, medical science knowledge and evidence is expanding at a pace the individual isn\u2019t capable of processing, especially the busy clinician.<\/p>\n
So, what to do? \u00a0Consolidate, collaborate and commit. \u00a0<\/strong>Consolidate into integrated networks where scale can allow for physicians to organize in such a way to allow for proactive process and pathway development and maintaining.\u00a0 Collaborate across disciplines, departments and care settings to create more patient-centered, effective, efficient and coordinated care processes and clinical pathways that breakdown traditional provider and setting-centric boundaries.\u00a0 Commit to a new way of managing care and changing the current system with its poorly aligned incentives and poorly coordinated components.<\/p>\n