Category: System

Ben Franklin told a young tradesman, “Time is money.” In an age of distraction, everything takes time. Economists call it opportunity cost. Do you stay out late after dinner, or prepare for the next day? Is an eMBA worth the effort?

Successful businesses know that new work costs money. Either old tasks go undone, or you hire staff to tackle new projects. Corporations go broke if they don’t pay close attention to how workers spend time on the job.

Stealing Millions from Patient Care – One example

Our team received a final notice from our site admin. Every physician must complete a survey, or we lose funding for our electronic medical record (EMR). The survey had close to 100 questions and took 2 hours to read carefully and answer accurately.

[Full disclosure: I love EMRs, IT and clinical tools of all sorts. I think we need more informatics, not less.]

Over 11,000 Ontario physicians on EMR x 2 hours = 22,000 hours of clinical time spent on 1 survey.

 = 9.6 years (22,000 / (50 hours per week x 46 weeks per year)).

 = $3.252 million for 1 survey [9.6 years x $340,000 (average gross billings)]

Of course, time spent away from clinical care saves the government money. Docs get dozens of similar non-clinical requests.

Administrative Off-Load

Efficient hospital-based medical groups remain on high alert to admin off-load. Hospital administrators love to build arguments for why a specific administrative task requires an MD (e.g. RM&R forms for community nursing, Transfer forms for mental health patients).

It saves hospitals money. If they can convince docs to do something, it means they don’t have to hire staff using hospital funds. MDs get paid from OHIP, not hospitals.

Laziness and Efficiency

Vice often drives virtue. Laziness makes us to look for easier ways to work. My Scottish Granny might have harrumphed, “You find shortcuts so you can do MORE work, not less!”

Ok. But we still don’t spend our time looking for ways to make work harder. Unless you’re a bureaucrat. Bureaucracy slows things down, resists change, ‘manages’ innovation.

Bizzaro World

In nationalized services, governments save money by slowing down their most expensive assets. They save by shutting down MRIs, closing operating rooms and shackling physicians with as much non-clinical work as possible. Up is down and down is up in Bizzaro world.

$3.25 million dollars of potential patient care wasted on one survey is only a shaving off a lumber pile of waste. If politicians were serious about efficiency, they would insist on freeing up doctors so patients could receive more care.

But more care costs money; who wants that?

photo credit: currencyguide.eu

Politicians dream of efficient healthcare. Patients look for service, access and quality. Physicians want freedom to deliver outstanding, high-quality care designed around patient needs, not bureaucracy. We all want superlative healthcare.

It already exists. Or at least it could, if we let it.

The secret does not lie with integration, IT, collaboration, transitions of care, prevention, oversight, quality management, screening, or all the other things you hear about. These all help and are necessary. But none of them can do everything.

The Secret to Superlative Healthcare

The small doctor’s office offers the best hope for patients, politicians and providers. Here’s an example:

A physician showed me her clinic recently. She holds the mortgage on 1000 square feet in a newer professional strip plaza and renovated it to hold up to 3 physicians (only 2 currently). Twenty-foot ceilings allow for a mezzanine. It is simple, clean, bright and attractive. She works 6 days per week, with one full time and one part-time secretary. A massage therapy clinic leases a mezzanine and offers easy access for her patients.

She knows all her patients – has a relationship with them – and wants to see them healthy. Her patients know she’s devoted to them. She shows it.

But she also wants efficiency. She knows that waste means fewer resources for her patients.

Owner Operator

If her patients need mental health services, in-office nursing care, or any other allied health service, why would we design a system that sends patients away from an office like hers?

If we funded this physician to hire a healthcare worker, we have every reason to expect that she’d apply the same expectations of patient-focused, high-quality, efficient care for the new staff.

Would she tolerate

• Long breaks between patient visits?
• Notes that require more time to write than time spent with patients?
• Leaving appointments open on the schedule?

Never.

She would expect the same focus on patient service and efficiency that she applies to herself. Wasted resources mean fewer resources for other patients.

New Programs

So, why do bureaucrats insist on creating new behemoths, with weighty tomes of policies and procedures, so that allied health can ‘integrate’ with primary care, in a separate location? How does this help patients? Every new solution seems big, and wasteful.

Of course, not all offices run like the one described. But many do. The ones that do not, go out of business or move into government run clinics.

Superlative healthcare starts with small physician businesses. Ideology prevents government from ceding resources or control to physicians. Government wants to control as much as possible. It needs resources for the bureaucratic giants it designs and runs.

Small is Good for Patients

We do not use the excellence that already exists. Let’s let physicians lead and design care around patients’ needs. Let’s push government into a supportive role and let the front-line professionals meet the needs of patients they know and love.

Physicians could replace the work of many bureaucrats if they were allowed to manage resources through their own offices. The secret to superlative healthcare isn’t radical. It’s obvious. But it might require fewer bureaucratic jobs.

It’s difficult to get a man to understand something, when his salary depends on him not understanding it.

Upton Sinclair

 photo credit: cnn.com