Category: System

Healthcare Accountability vs. Healthcare Incentives

Power Struggle Between a Man and a WomanWar erupts when:

Bureaucrats demand accountability without expecting to pay for it.

Physicians expect incentives without any accountability for outcomes.

We need both. 

Accountability without payment = slavery.

Incentives without accountability = robbery.

No accountability or incentive = retirement (or tenure, or union seniority, or sinecure)

We need rigorous accountability AND meaningful incentives.  We need system leaders to be comfortable with both.  We need experts able to align incentives and reward outcomes that benefit patients.

But, accountability presupposes freedom. 

Accountability must be demanded inversely to the amount of rules given:

If payers micro-manage every system process and detail, they remove freedom from providers and have no right to demand accountability. 

Give providers freedom, then demand accountability.  It makes no sense to demand accountability without giving providers freedom to deliver results.

What do you think?  Do we need more accountability?  More incentives?  More freedom?

Medicare vs. Patient Care

i_love_medicare_stickerConference participants wore ‘I Love Medicare’ pins in Calgary.

Nietzsche might ask

Do you love medicare because patients benefit, or do you love medicare because you benefit?

Do you love ‘free care’ more than patient care?

People can care more about the idea of universal health care than they do about the care patients receive.

They deny data showing

long waits

poor patient outcomes

lack of access

lack of coordination

high cost

inefficiency

lack of control

provider frustration

Their solutions focus on

more control

more funding

more rationing

more cuts to salaries > 100k

more patient education to divert access

They would rather fight for a failed system than fight for improved patient care.

dog-ma-tism

n. An arrogant, stubborn assertion of opinion or belief

dog-ma-tism n.

1. positiveness in assertion of opinion especially when unwarranted or arrogant

2. a viewpoint or system of ideas based on insufficiently examined premises

Medicare dogmatism will guarantee mediocrity at best.

We need a system that:

puts patients’ needs first

makes patient experience central to funding

gives patients great access

offers patient choice

guarantees quality care (Quality should be a given)

demonstrates business excellence

attracts the best leaders

rewards great outcomes; not mediocrity

aligns incentives for every provider

rewards grass-roots provider innovation

gives control to health-care experts

This can happen in a publicly funded system, but it will never happen if people resist change.

We need to stop thinking that health-care is so special, complicated and unchangeable.

Do we love medicare more than patient care? Can we have an adult conversation about change?  What do you think?

Are Unions Killing Healthcare? Should We Fire Them or Add More?

MP900341718Unions helped improve working conditions in the mid-19th century industrial revolution.  But what have they done for PATIENTS lately?

Unions did great things for manufacturing, but have they done ANYTHING to improve service?

In a publicly funded healthcare system, does it make ANY sense to have unions?  Don’t government jobs already have good salaries and benefits?

Have unions improved anything for patients?

Have they increased efficiency?

Customer service?

Quality?

Innovation?

Choice?

Do unions improve anything other than salaries and benefits for their MEMBERS?  Are unions all about protecting seniority instead of promoting skill?  Are all unions the same, or do some care about something other than themselves?

Jeffrey Simpson writes in ‘Chronic Condition‘, that governments can’t “…break union rules that make surgeries happen to fit the convenience of providers instead of patients…” (p. 41).

In a world of evidence-based decision making, is there any proof that unions add value for patients? 

Unions drive up wages and create MANY extra layers of bureaucracy in hospitals just to manage union issues.  A platoon of nurse leadership and human resources staff spend hours managing unions.  Not employees . . . unions.  Would the public support the extra costs of dealing with unions? 

Increased wages, increased hospital costs, patient access decreased…

We need reform based on patient need.

We need to measure outcomes and hold unions accountable.  We need to look at the total cost of unions to healthcare and have them find efficiencies.  We need to examine the impact unions have on patient mortality and morbidity due to unions refusing care unless wages go up or work effort goes down.

Unions exist for themselves.  Unions do not exist for patients.  This has to change.

Should we empower hospitals to get rid of unions or expand them?  Do you have evidence showing that unions benefit patient access to care, quality, and customer service?  Please leave a comment by clicking Leave a Reply or # of Replies below.  Thank you!