Category: System

This post could be titled

“Simplify healthcare to save money, improve patient service, transform the experience of care, drive outstanding quality, increase morale, decrease administrative costs, reduce errors, minimize frustration, reduce burn-out, retain experienced clinicians, increase joy at work and so much more.”

In healthcare, we pursue good things instead of important things and complicate care in the process.  Everyone working in healthcare has the power to make simple things painful and complicated. Leaders especially.

Take information technology. IT experts value security and privacy, which are both good things. But they complicate life with timed log-outs that make users sign-in again and again, forced password changes every month, multiple portals just to see one patient’s results, and firewalls that block clinical sites. They complicate care.  They can ruin a great experience while trying to do something good.

We pick on IT because it’s easy. But everyone can choose to simplify healthcare or make it nasty, brutal and long. New forms, checklists, rules, legislation, processing and dozens of other things can make care hard, slow, painful.

Simple takes effort and does not happen by accident. The Toyota approach to LEAN manufacturing has helped 100s of hospitals provide better care with less effort and waste. But it requires intention and hours of expertise to cut out useless work.

Ockham of Healthcare

Maybe healthcare needs a committee designed to axe committees? It could look at every process, legislation or regulation and ask,

“Does this simplify healthcare? If not, is there a simpler way to get the same or better outcomes?“

If it looks like there might be a simpler way, the committee could ask those who came up with the process to try to make it simpler.

Science informs modern medicine. All things being equal, science loves simplicity; it lives by Ockham’s razor. Ockham’s razor, or the law of parsimony, says we must not multiply explanations beyond necessity.

Maybe we need an Ockham’s razor of healthcare: Do not complicate beyond necessity.

I wrote about the legislation epidemic as have many others. Here’s a short list of some of the work being done mostly outside Canadian healthcare:

• Ministry of Administrative Simplification  “Healthcare is turning into an industry focused on compliance and regulation rather than patient care.” Forbes.
• The effects of healthcare over-regulation. 
• How government regulations made healthcare so expensive. Von Mises
• Healthcare regulation a $169 billion dollar tax. Cato
• Deregulation task force in Australia
• Canadian Red tape reduction action plan and reducing red tape.
• Administrative Burden Baseline 
• Reforming regulation 
• Over-regulated America. Economist
• List of Health legislation in Alberta (Ontario needs this!)

Simplify Healthcare

Simple takes effort. Some jobs depend on healthcare being complicated.  Some people get paid to keep things complicated. Will we work and sacrifice to simplify?

You can expect 4 features from almost all government services: paper, process, waits and privilege.

As every other industry moves away from hardcopy and convoluted processes towards convenience and transparency, Medicare pushes a wheelbarrow load of forms, complicated process maps, painful waits and privileged access.

Consider a recent trip to the Ministry of Transportation.

We stand in a line that stretches ten people in front and as many behind. People fight off numb feet by shifting from one locked knee to the other. Some stare at the ceiling, mouths half open. Like stuffing escaping an old couch, ownership papers and safety certificates stick out under folded arms.

A car dealer interrupts our REM cycles. He has a big smile, noisy shoes and forced laughter. He owns this office.

He leaves. We’re still in line. Another dealer swaggers in a bit later. The clerk giggles at his grin.

The staff seems busy. Each cubicle wall holds file folders intent on vomiting paper.  Old-fashioned computer printers scream out perforated paper. Clerks tear, rip, stamp and sign. A paper jam requires two staff with special tools. It holds up all the other print jobs.

At the front of the line, a clerk asks why we’re there. Sorry. You’ll have to wait for a different agent. The next agent frowns when we show him our paper. Follow me. He ushers us down to a special counter at the back of the room, barely visible from the front, to wait behind a dealer.

Thirty seconds after speaking to the special desk, with four pieces of paper in hand – including receipt for payment – we toddle out thankful to feel the edema squish out of our feet.

Though the wait was painful, and the process impossibly convoluted, we leave impressed with the expert service provided by the person at the back of the room.

4 Features of Government Healthcare

Nationalized services have core similarities: paper, waits, process and privilege.

In healthcare, we still print, scan and fax things into and out of our electronic medical records. Whether it’s a consultant’s office, the emergency department or a local clinic, we put patients through multi-step processes for everything no matter how simple the problem.

Never assume you have a simple problem for a government service to fix.

Patients see their doctor in one place, go somewhere else for blood work, a third place for X-Rays and then wait weeks to discuss the results. But for those with connections, waits shorten and process becomes almost convenient. The forms, paper and charts usually cannot be avoided.

Does any other industry work like this? Airlines? Dentists? Auto mechanics?

Renovate vs. Demolish

In the movie Tomorrowland, the heroine asks, “What are we doing to fix it?” Despite the utopian promise, it presents a worthy challenge. Faced with bad news, we must choose to despair or resolve to fix it.

Medicare could use much less paper. It might become electronic as a way to serve patients, and not just as a means to control data.

Medicare could simplify processes. It would be hard to remove special interests that resist streamlining, but not impossible.

Waits could almost disappear. They create more work, not less. Doing work tomorrow that could be done today costs more, too. Canadians wait for many reasons, but mostly because we institutionalize waiting. It’s not necessary. And it’s not about money. Most incentives align to create waits. Other countries do not allow it.

Finally, we could offer all patients privileged access and service. Just like the Ministry of Transportation office lets the car dealers skip to the front of the line, Medicare could offer great service for everyone. But for now, there’s no reason to do it. In fact, being able to coordinate access and care for family and friends remains a special perk of working in healthcare for some people.

Can we envision a day when the 4 features of government healthcare disappear?

photo credit: teen.com