War 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?
This brilliant. It’s such a simple concept that policy makers overlook.
Who do we need to get this message across to?
Thanks Eddie!
There’s a mistake I realised in my sleep last night: I forgot to change freedom to rules in one spot. Lots of accountability cannot exist when there are tons of rules.
I had help coming up with ‘robbery’ and ‘sinecure’.
Sure appreciate you reading and commenting!
Cheers
Shawn