When I write or speak about healthcare transformation, I am often asked why I do not criticize more. Criticize health system leadership. Criticize governmental policies. Criticize burdensome regulations. It’s a long list. Why avoid criticism? The answer is simple. Discerning emerging solutions is much more productive and fun.
We are living during a very interesting period in the history of health care. No doubt, it is a time of great transition. We are passing from one time to another. Transition periods are important, yet they are hard to define because it’s difficult to determine exactly when they start and when they end. To understand the transition healthcare is now experiencing, we must do our best to understand what is on either side of it.
The traditional approach to delivering care has served us well and accomplished great things over the past century. Yet, it is also being overwhelmed by complexity and producing inconsistent quality, unacceptable levels of harm, too much waste and spiraling costs.
The traditional method of delivering care is struggling and another is emerging to take its place. Because the traditional approach has served us well and accomplished great things, we want to believe that the present state will continue forever. Because conditions have changed, this will not happen. We are in need of a new approach. An approach that carries the best of the past forward, yet also addresses present day challenges. It just might be that on the other side of this current transition is potentially a time unmatched by any other in the history of healthcare. Thanks to visionary clinical leaders at institutions across the country, there is growing evidence this is not only possible; it is likely.
Who does the future belong to? If we look closely at other transition periods in history, two groups of people are apparent. The first are what we recognize as critics. They are people whose response to the need for change is criticism. Critics always exist, but in a time of transition they tend to multiply. What do they criticize? They criticize the new, they criticize the change, they criticize the change for being unnecessary or too fast, or they criticize the change for being too slow. They criticize anything and everything. Critics are abundant. The question we should consider is, “Will criticism solve problems?” Typically, it does not. While constructive criticism has its place, it alone is not likely to accomplish much especially when the world is yearning for innovative solutions.
The second group of people that major transitions yield is leaders. They are men and women of vision, courage, persistence, integrity, creativity and enthusiasm. They see transitions as periods of opportunity. They have the ability to ignore the turmoil, confusion and difficulties that characterize transitions, and remain focused on the task at hand. They look into the future and imagine new possibilities. Yet, they spend the majority of their time in the present working tirelessly to bring a new vision to reality.
They eagerly share their vision and enlist the support of others in pursuit of the vision. They tend to be excellent communicators both in word and action, and their presence alone energizes and inspires people. No matter what the odds, doubts, and criticisms, they carry on, and eventually, they are recognized as heroes. Is there evidence of this happening now? Yes, there are many. Let’s examine just two.
With the help of good data and modern quality improvement methods, clinicians at North Memorial Health Care reduced elective inductions by 75% within just six months. In the process, they improved the quality of care, reduced harm and received a six-figure payer partner bonus. Using advanced analytics, team-based processes and evidence-based best practice, clinicians at Texas Children’s reduced appendectomy postoperative length of stay by 36 percent, dropped average variable direct costs by 19 percent, increased evidence-based order set adoption by 36% and increased the percentage of patients receiving recommended antibiotic as first antibiotic by 53 percent. There are hundreds, perhaps thousands, of other examples.
The future belongs to people such as these. They are leaders. One rarely hears them criticizing anything or anyone, because they are too busy getting the job done, deigning a new and better way of delivering care. In the process, they are defining what is on the other side of the transition.
The future will be what we make of it. Leadership is not a special class. It is a role each of us can assume. It is a position of influence. No doubt, some people are able to exert more influence than others, but all of us can have an impact, especially collectively. The voice of clinicians can be profound, particularly if our sincere goal is improving care for patients. People will hear what we say. They will listen and be affected. Many are eager for clinicians to act in this fashion. They need us to be confident, optimistic and visionary. Let’s not disappoint.
We should not fear the proclamations of critics. In the face of criticism, I like to carefully reflect on a quote from a 1910 speech by Theodore Roosevelt.
“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”
It is time for leadership in health care. Let’s criticize less and dare greatly more.
John Haughom, MD, former senior vice president of clinical quality, safety and IT for PeaceHealth, is a senior advisor to Health Catalyst and the author of “Healthcare: A Better Way. The New Era of Op
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“Yes, it’s called “have your cake and eat it” conservatism.”
Saurabh, again you are generalizing and using that binary mind. People are not necessarily consistent nor must they follow a consistent political line. Are you trying to sound like a raving Liberal in drag using soundbite generalities rather than appropriate argument? (This remark is not intended to criticize the normal Liberal mindset.) In general the right does not follow in lockstep as some presume the left does. We need to discuss concepts rather than soundbites.
“government, hands off my government.”
I am sure you recognize the people not of the left believe in government, just not to the same extent. Government is needed for a strong marketplace to exist, but it doesn’t have to make one lose their liberty or their economic freedom.
You talk about revealed preferences. Are not your primary preferences liberty and economic freedom? Your preferences seem to indicate a different mindset though perhaps that is only in this venue. Do you want lockstep adhesion to a philosophy? If one wishes that type of lockstep adhesion they ought to be thinking about a socialist totalitarian state that I don’t think anyone here desires.
“For many reasons a man can vote and intellectually support conservative or classical liberal ideas, but might still want the Medicare he paid for or want to support a pet idea inconsistent with those philosophies. ”
Yes, it’s called “have your cake and eat it” conservatism.
Or “government, hands off my government.”
I do not underestimate the ability of some conservatives to justify why their slice of the government is morally earned and slice of others,
handouts.
It has the GOP in a bit of a bind. They know not of any free market solutions which would keep social security solvent in the long run but which would not inconvenience their traditional supporters in the short run.
The left have the same problem with their champagne socialists, which is why the democrats stayed away from single payer and the public option in the ACA.
Revealed preferences are more revealing than stated preferences, allan.
I am not willing to rob people of their moral agency.
I await with baited breath the debates and results of the next presidential election to see what, in the aggregate, people really want.
“allan, whether I am a juvenile, puerile, … “
It does matter because you have been engaging in the use of logical fallacies along with a bit of clever deception and I believe you know it. Again, maybe I am wrong and could be giving you too much credit.
Let me give you an example of just one of the logical fallacies you used.
Tea Party: “Government hands off my Medicare” You might have seen a few signs that said that exact quote and from that you drew your conclusions regarding the Tea Party. You generalized the few to the many creating a false generalization that you then used in argument. Your training tells you what you did was wrong.
Most of the members of the Tea Party do not have Medicare.
Just because a very few of those carrying the sign were amongst the Tea Party members doesn’t mean they were part of the group, nor that the vast number Tea Party people there agreed with them.
You generalized figuring it sounded good in argument when you knew or should have known that such a generalization is a logical fallacy.
We have no significant argument over “a”. “b” is another story as it to leads to a logical fallacy. I think in a way Don Levit was close when he pointed that out to you “ how the world is, and how it should be.”
For many reasons a man can vote and intellectually support conservative or classical liberal ideas, but might still want the Medicare he paid for or want to support a pet idea inconsistent with those philosophies. If I am correct when polling the American population with regard to the usual use of the term left and right it has been found that the American public is center right.
You don’t have to eat dirt and wrap yourself in drama. Many conservatives and classical liberals would object to ridding our country of Medicare a promise made to the American people and one that all too many are now dependent upon. Before you commit another logical fallacy recognize that these same people did not support or would not have supported Medicare in its present form. Likely if given a choice many would have preferred the King-Anderson Bill or other bills targeted only to those in need.
“This thread is the best example of how the American right is unable to distinguish the normative (ought) for the descriptive (is), and shoots the messenger!”
I disagree totally though the above might apply to you. I believe that disagreement occurs because you think with a binary mind that you accuse others of. Your personal perception of right and left seems to neglect the possibility of other philosophies that leaves the door open to alternative explanations of how differing individuals act and react. If you weren’t stuck in such a mindset you would have seen other alternatives that exist.
Saurabh, relax and have a pleasant day. You are a smart and decent guy.
Don,
I’m just observing! That’s all.
allan, whether I am a juvenile, puerile, socialist, Satan’s spawn or even the devil himself.
That does not change the reality which is:
a) A constitution is only as restrictive as democracy and culture permit.
b) Your country men love, adore, can’t get enough of big government.
If the GOP produces a challenger who wins the next presidential election on a platform of privatizing social security and creating vouchers for Medicare, I will forever eat dirt and prostrate before thee oh Lord!
In the meantime if there is anything I can do to convince you that I am a communist who eats Irish babies, please let me know!
This thread is the best example of how the American right is unable to distinguish the normative (ought) for the descriptive (is), and shoots the messenger!
I think it should be retained permanently for future historians.
“You do have one advantage, allan: you hear what you believe. I have one disadvantage: I see what I see.”
This is a bit simplistic and tripe coming from an educated man. We all color what we hear and see. This exchange is in black and white so I need not repeat what has already been written, but I do note your tendency to change the context of what was said and how it was said. In fact some of the things you state as your ideas in this reply are in fact mimicking those words of mine you reviled.
Maybe what has transpired is a good thing for you as now you might have a better understanding of democracy and what constitutes a Constitutional Republic. You even seem to have learned what Jefferson and others taught us and that is the public will determine the future of the Constitution. I have no argument with you there. Maybe you knew all this before, but how am I to know one way or the other with all the soundbites and simplistic tripe you have been peddling in this particular conversation.
Your responsiveness has mostly been juvenile while making all sorts of claims in this latest one that sounds like something you pull out of a book of insults and list without regard to substance. Should I answer this list of insults one by one? No. It should suffice that I told you where I stood and stand on particular issues.
Yes, I believe in free markets because that has made the world richer and this country strong, but I also believe in compassion. I believe in individual rights. As I stated before I favor the utilization of the marketplace and because a marketplace can be thought of as apolitical I don’t find the need for big government or a lot of politics where soundbites are directed to win the heart rather than the mind.
Where you stand, I really don’t know. At times you seem to sound like an ideologue and have contempt for America and Americans that are just normal people trying to get by. I’ll get to the chase and skip the direct reply to all the insults and let you correct those impressions about you or alternatively you can leave them stand.
The simple statement that we ought to “criticize less” (NOT criticize ever or criticize never) – just criticize less and constructively build more certainly generated a lot of interest and comment!!!
Don… Thank for you thoughtful and refreshing comment.
Saurabh and Allan:
I was directed to this blog, but Saurabh’s comments were not posted.
Allan, if you received them, if Saurabh is close to being accurate in his comments, I would leave it as it is.
Saurabh:
I hope you can hold 2 contrasting ideas in your head at the same time: how the world is, and how it should be.
As far as the extremists on the left and right, if one goes too far right, he sees the same idiots coming around from the left.
Don Levit
Alex
Thank you for commenting and sharing the link. It was very interesting. In the future, focusing on nutrition and prevention will be huge. One of the most interesting aspects of Big Data Analytics in healthcare is that it offers a very real potential to understand and influence behaviors.
One of the most-cited statistics in public health is the imbalance of
social investments in medical care compared with prevention activities. Approximately 95 percent of the trillions of dollars we spend as a nation
on health goes to direct medical care services, while just 5 percent is allocated to population-wide approaches to health improvement.5 However, some 40 percent of deaths are caused by behavior patterns that could be modified by preventive interventions as I discuss in my book. Genetics, social circumstances and environmental exposure also contribute substantially to preventable illness. It appears, in fact, that a much smaller proportion of preventable mortality in the United States, perhaps 10–15 percent, could be avoided by better availability or quality of medical care. Thus, one could question a funding scheme that places so much emphasis on medical care rather than prevention.
The fact that medical care historically has had limited impact on the health of populations has been known for many years. The data clearly indicates we could achieve a much greater impact on total health by going after behaviors than by delivering care.
To put this in perspective, a study published in the British Medical Journal tracked approximately 35,000 people over about 20 years. The study looked at 4 behaviors related to health (tobacco use, appropriate alcohol use, diet and exercise) and demonstrated that people who did well on all 4 compared
to people who did poorly on all four accounted for a 14-year difference in life expectancy. Compare this to all of healthcare delivery accounting for approximately 3.5 to 7 years of additional life expectancy.
Preventive health has huge potential. As I said at the outset, Big Data Analytics offers many advantages here. Hence, Google’s recent announcement that it is seeking 100,000 volunteers to study this possibility.
Yes pcb, and contrast that with this:
http://www.medscape.com/viewarticle/830845
You do have one advantage, allan: you hear what you believe.
I have one disadvantage: I see what I see.
That aside you seem incapable of distinguishing between someone pointing out reality (this is the way the world is) and justifying reality (this is the way the world should be).
I point out that your fellow citizens love the security from big government (the way the world is). You defend by giving me a lecture on the virtues of free market (the way the world ought to be).
I point out that the constitution is only as good as the democratically elected leaders and the supreme court justices appointed by the leaders decide (reality). You give me a lecture on mob rule and the difference between republic and democracy.
I point out the fact that the free market champion, Paul Ryan, in the last presidential campaign appealed to seniors that they may lose their Medicare benefits under Obama, shows how advanced your country’s dependence on government is. You defend by calling me a socialist.
Were I to point out that a building is on fire, and someone retorted by saying “so you think fires are good for buildings, do you, it would sound absurd, would it not?
That is exactly what you are doing.
This is worse than shooting the messenger because you don’t like his message.
I have encountered this malady before, but never with such defiance that I see in your responses.
I really find it difficult to believe that you don’t get the difference.
Why so? I suspect you are unwilling to hold two seemingly contradictory thoughts in your mind at the same time. The pain of reality is too much for you to bear.
Yes, I do think all idealogues converge. The far right and the far left are more similar than they think.
This is a well known phenomenon in political science, in the understanding of which you claim to be better endowed.
http://en.wikipedia.org/wiki/Horseshoe_theory
Idealogues are not extremists, they may be that as well.
Idealogues are hypocrites.
“Hands off my Medicare” is the perfect poster child, though not the only example, of that utter hypocrisy.
I do not believe free markets, limited government and a constitutional republic are a joke. I do believe that the BELIEF that in modern America these elements run through the veins of its citizens is a joke.
I hope you will not insult your intelligence by failing to acknowledge the difference between these two statements.
In short, I think your country men love big government. They just can’t admit it.
Here is something from the right winger, Mark Steyn.
http://www.ocregister.com/articles/percent-379256-government-spending.html
Saurabh, I missed the Vox reference because it was neither clear, equatable nor exclusive. It also misses the fact that the mainstream news media are considered by many to be left of center and that is where the comparison would have been clearer and perhaps should have been made. Vox Media at the present time is a near nothing.
I favor the marketplace. That is economic and not really political. Because I favor the marketplace I require less government and less politics. I believe in the Constitution because it acts or should act as a consistent anchor to keep the ship midstream. I don’t necessarily agree with everything in the Constitution but I will abide by it because it creates stability and has proven value. I believe in balanced budgets because I don’t believe it ethical to spend on myself and force someone else to pay for it.
I don’t know much about you though from your writing I know something about your feelings towards America which don’t sound very positive. Based upon your words it seems you think the American Constitution somewhat of a joke and the belief in small government, the Constitution and balanced budgets are extremist thoughts. You act as if you are solidly locked into the concept of democracy which means that 51% of the people can vote the other 49% into slavery. Is that what you believe or perhaps you never looked at things that way.
You talk about a binary mindset and reality. My suggestion, stick to radiology because you don’t know very much about psychiatry. You talk about ideologues, theory and a whole host of other things. Again my suggestion is for you to stick to radiology because you don’t know very much about political science and have not been able to make a coherent argument to enhance your position.
I think you have to take a step back and consider what you have been saying in the context of the discussion. Then I think you should start anew.
Yes I recognize your profile is open while mine is unknown to you, but not unknown to many on this blog. By having your profile open you have the advantage. You can demonstrate your degrees and education and assume people will consider you a learned man. I have a much greater obstacle to overcome. I can only use my words on this blog and people have to determine who I am through those words. Thus I have given you the white king and I have taken the black one.
allan, do bear in mind one thing.
My profile is open. You know where I work. But I know nothing about you.
That’s fine. But remember: it is you ducking under the safety of anonymity not me.
http://onhealthtech.blogspot.com/2014/08/the-study-youll-never-hear-about.html
Maybe we can keep talking about this and force those holding the purse strings to talk about this study?
allan, you missed the Vox reference because it didn’t occur to you that a person criticizing the right can also find the left equally pretentious.
This is a function of your binary mindset. All evil lies on one side, or the other.
You are unable to deal with the complex thing called reality because like the Marxists, progressives you reduced cause and effect to one deterministic theory.
There’s a theory in political science, the horseshoe theory, which states that the far left and the far left are not terribly far from each other.
You are exemplar of the theory, and also of the fact that the most dangerous people in the world are ideologues, whether they are unwavering religious fanatics, Marxists or free market (but government-sucking) fundamentalists.
I will argue them. All the way.
“ why would I be talking about German media when I’m referring to American -across the spectrum-media bias?”
Because you could have used the three major broadcasting networks in your example and you chose not to. You chose something more obscure, but I am more familiar with Vox smart phones and Vox German TV than I am with a brand new tiny digital media company that is more similar to Glen Beck TV though Beck’s might be a more stable media company.
“Are you auditioning for Saturday Night Live?”
Absolutely not. I have seen what you have written and there is no way I would try to compete with you in the realm of fiction and comedy.
“Constitutional Republic? How is the “constitutional” bit working out for you?”
Far better than what we are seeing in other countries. How does dictatorship sound to you?
“ You really can’t grasp this, can you?”
You are starting to sound like my grandchildren. Grow up.
I am looking at your follow up questions and along with being inaccurate they have no content and are out of context with what I stated above. I expected this type of talk from my children in grade school, but not from someone at U of P. In this exchange you have made a total reversal of who you were in other exchanges and on other blogs. I suggest you review what was written so you better understand what is and is not being said. I suppose you are now revealing your true character or is this just a trial audition of another personality.
Don,
I saw little evidence of majority dissent against the fiscal, economic and healthcare policy of the preceding four years during the last elections, to the extent that people found the policies so objectionable that they wanted to change the chief executive of their country.
But let the next GOP challenger run on a platform that remedies the policy failures you cite. Specifically on a tight monetary policy, reduced and specified government spending and privatization of social security because of future insolvency and a complete voucher system for Medicare.
Go on! I dare the GOP to put forward such a candidate! What are they fearing in a country which has market principles and limited government running through its veins?
Our thought leaders have brought us the PCMH, pay-for-performance, and assumption of risk by physicians. The recent Health Affairs article shows that none of these correlate with a low rate of preventable hospital admissions: that desirable goal is seen only with physician-owned small primary care practices, which our thought leaders are trying to destroy.
Is it any wonder that we “criticize the new, criticize the change, criticize the change as unnecessary or too fast . . . ?”
“The ACA represents insurance coverage reform. It does little to substantively improve the process of care for the patients we serve.”
Well, that is for sure. Why can’t we leave the poor government out of all this?
FGS allan, why would I be talking about German media when I’m referring to American -across the spectrum-media bias?!
Are you auditioning for Saturday Night Live?
“No. America is a Constitutional Republic. There is a difference, something that you seem unwilling to recognize or unwilling to learn.”
Constitutional Republic? How is the “constitutional” bit working out for you?
You really can’t grasp this, can you?
It doesn’t matter whether you have convinced yourself that I understand the nuances (I can’t vote and am too insufferable to run for office), if those who are elected, those who vote and those who comprise the judiciary do not understand the nuances of a constitutional republic.
What next allan?
Are you going to restrict democracy to those who understand the difference between a democracy and a republic?
Or are you going to restrict voting to those who understand the difference between a democracy and a republic?
Or just run to the supreme court like whining ninnies saying “look the President broke the constitution?”
You are shooting the messenger here. A messenger who is stating, and will state again, your country loves big government and there’s absolutely nothing you can do about it.
“Perhaps it deviates from your more socialistic tendencies that are always associated…”
So I’m either with allan or the socialists! Oh, the intellectual depth of the binary mind!
“It wasn’t me guv, the government made me dependent on the government…”
Saurabh, are you back to believing that America’s basis for existence is the singular democratic vote? No. America is a Constitutional Republic. There is a difference, something that you seem unwilling to recognize or unwilling to learn. Perhaps it deviates from your more socialistic tendencies that are always associated with governments that believe they give rights to the people instead of this country where the people gave rights to the government.
I know it is tough to envision that some people believe that government gets its rights from them, but that is how America’s founders saw it. That is why they liked things that you seem to disdain, balanced budgets, the Constitution and small government. I so happen to stand on that side rather than on the side of political despotism where one’s vote is determined by how much they can suck off the government’s largesse. Each to his own.
Yes there are many that want the government in every aspect of their lives and to provide for them to such an extent that they depend upon future generations to pay for it. They are too foolish to recognize that as a step towards devolution into that vast ocean of despots and poverty from whence they came. It is from that ocean that that some people decide to immigrate into the United States.
This is a nation of immigrants. Why are we here? The culture of the old country didn’t provide freedom, economic and otherwise. Why change the culture back to the one from which one is escaping?
You say: “Go on. I dare ya! Put your free market principles where your votes are!”
Those free market principles are what made the United States into the strongest nation of the world. Knowingly or unknowingly you are trying to tear it down.
“Have you really not heard of Vox news run by Ezra Klein? I think you need to get out more.”
You are not talking about Vox, but Vox Media a very recent entry into the digital media world which is even a worse comparison than Vox tv, a German company that has been around for quite awhile and has proven itself being one of the largest of its type in Europe. [for your edification: There are a lot of entities carrying the name Vox because Vox in Latin means voice.] Go back to Jon Stewart and Saturday Night Live. At least they are funny. … You are suggesting others need to get out more? You are laughable.
Saurabh says that government does nothing unless the people support or tacitly approve
Would that include Quantatative Easing and bailing out the big boys?
Would that include keeping interest rates at zero for five years so that savers suffer the loss of legitimate time value of money?
Would that include forcing the stock market to rise while the median household income dropped from $51,000 to $46,000 over the past three years
Those who support Medicare and Social Security
Do so either because they do
Not know the trust funds are filled with debt instead of the excess FICA contributions which were used to pay other federal expenses
That would be like an insurer using its reserves to buy back their stock to artificially increase the price
An insurer that depleted their reserves to enrich the stockholders would have a cease and desist order issued by the state department of insurance
The federal government is not able to accumulate money for future use
Don Levit
I’ve never heard so much criticism of criticism in my life.
“It might seem that way based upon what our government has been doing in recent decades”
Robbing moral agency, allan! How very progressive!
“It wasn’t me guv, the government made me dependent on the government and vote for that dependence.”
The government does nothing the citizenry do not actively support or tacitly approve.
Once again I’ll say: your country loves big government, including denizens on the right.
I dare the GOP to put forward a free marketeer against Hillary that in his/ her manifesto privatizes social security and Medicare.
Go on. I dare ya! Put your free market principles where your votes are!
If you do not find the Tea Party placard “Government hands off my Medicare” or Paul Ryan’s appeal to seniors that they might lose their slice of big government absurd precisely because these exemplars of free market, then you are devoid of even single strand of irony.
What’s their next placard? “Government, hands off my Obamacare!”
Have you really not heard of Vox news run by Ezra Klein?
I think you need to get out more.
Touchy? Perhaps, watching a great country be consumed by guilt and stupidity.
The use of Fox has already become more than just a comparison, but perhaps I should forgive you because you might be unaware. Vox which I believe is German is not comparable to Fox. Maybe you were just trying to make things rhyme, without any rhyme or reason.
“The same country where the Tea Party, that beacon of free market capitalism, used as its battle cry “government, hands off my Medicare?”
Nice soundbite, but it is demonstrative of a feeble attempt to use innuendo instead of how did you put it? Adult discussion. The Tea Party supported three major ideas. A balanced budget, the Constitution and smaller government.
In every group people might have divergent ideas from the basic principles of the group so if just one person diverges the opposition can turn the unsophisticated with a simple soundbite. This seems to be an example.
Your tone could lead one to believe you don’t like what the Tea Party stood for or might stand for today (The movement has a multiplicity of groups, some with different agendas) . That would mean you don’t like the Constitution, balanced budget or a smaller government. I leave any clarifications that might be necessary up to you.
I am not quite sure what your point is about Ryan. He proposed his ideas. This country is a pluralistic society so we expect many different points of view, discuss them and hopefully come up with a rational resolution of whatever problems exist. Maybe you don’t realize this. Maybe you watch too much Saturday Night live or Jon Stewart and get your news from them. I don’t know.
My country likes big government? It might seem that way based upon what our government has been doing in recent decades, but it is founded on the principle of federalism and small government with limited powers. I’m guilty. I like the basic principles this government was founded upon and appreciate that certain distasteful things were abandoned.
You are right markets are messy, but effective. Dictatorship is much more organized. No discussion needed. Wood choppers abound. You portray the healthcare system in a black and white sense when it is a hybrid so some of the things you say are true though a bit on the hysterical side.
I’ll take the markets with a compassionate people over the wood choppers and poverty every day of the year.
You’re a little touchy allan! Which is why you picked up on my questioning Fox, not Vox!
“Yes it is true and I live in a country where the market economy thrived.”
The same country where the Tea Party, that beacon of free market capitalism, used as its battle cry “government, hands off my Medicare?”
Or government, hands off my government! That’s not Saturday Night Live!
So Paul Ryan, the free market musketeer, warns seniors that under Obama that leftie they could lose their Medicare benefits!
Is this your free market knight appealing to his foot soldiers, allan?
Live free or die, eh!
oh, allan don’t make me laugh!
Your country loves big government, can’t get enough of big government, runs to big government, even more than the Europeans!
Do you even realize that much of what big pharma produces would never have arisen were they not guaranteed to make a killing, guaranteed by big government, guaranteed by a myriad of regulations.
Markets are messy. Talk is cheap. No one has had to face them in healthcare in the US. You wouldn’t be able stand to them for a second.
“ I have a parsimonious view of markets.”
That is fine and probably good in the long run, but under certain circumstances not pleasant. We might want to a bit extra where significant unpleasantness exists, but we don’t have to destroy the marketplace to do so. Nor do we have to destroy the Constitution or remove individual rights.
Hypersensitive bore? …And you go off the handle because someone asks what is wrong with Fox after your whine?
I am glad you recognize that I have a bias towards markets. Yes it is true and I live in a country where the market economy thrived.
Yes the sale of iPads is different. So what? Every sector of the economy has its differences. I am sorry that you don’t recognize that.
We have more than just right and left in this country, but perhaps that is too difficult to understand so you consider anything that is not to the left as being to the right. Not very sophisticated, but I guess it will have to do.. I have news for you Saurabh just like there is a difference between healthcare and iPads there is a difference in political philosophies on the right and the left.
Next time you want to fix a label of hypersensitive take a look in the mirror.
In this day and age we can no longer be content to criticizes, but DARE to DISRUPT. The economic environment is changing quickly and no business including the healthcare industry will need to change also
You are making a good point, Merrilee. In the first Appendix of my recently published book, I talk about the role of complexity theory in healthcare and how healthcare is very much a complex adaptive system. As a result, you need to be careful when you try to fix one problem, you do not cause a worse one. As a complex adaptive system, healthcare requires an entirely different style of leadership. Much more sophistication and much, much better control of data to be sure you know what you are doing and the consequences of your actions. There is a lot of interesting and exciting work going on in this area right now. Thanks for sharing your thoughts.
Very well said.
Health care is like a balloon. Squeeze one area and another bulges…but if you aren’t looking or cannot measure all areas simultaneously you will miss the “equal and opposite effect”.
Even amongst patients, what has “value” for one, may not for another. Witness end of life/advanced care plans. They will differ from patient to patient.
A red flag goes up for me when I see “value” being used to determine what path a patient should follow. Consider the “value” of the Liverpool Care Pathway in the UK. Just say’n.
“Remind me, how did the VA deal with its internal critics again?”
You hit the nail on the head. Thanks.
FWIW allan, I have a parsimonious view of markets.
http://blogs.bmj.com/bmj/2014/09/04/saurabh-jha-the-sunnier-side-of-indias-free-market-for-medical-imaging/
I don’t think it would work here, because the moment someone encountered a wart, and there are plenty of warts in the market, they’d go running to big government.
Oh allan you’re turning out to be such a hypersensitive bore!
I know you have a considerable bias towards markets to the extent that you cannot seem to fathom why and how healthcare is different to buying Ipads.
But surely you cannot miss the bipartite media bias in your country? Right & left. That’s right allan, right as well as left.
Charles… I agree. Very well said. We have used value stream maps in virtually every improvement project I have ever been involved in, and every single time, the care teams have measured value in terms of outcome metrics that matter to patients. In fact, we often included patients on the improvement teams to assure that we did a good job at it. One could argue effectively that we should not measure value in healthcare in any other way.
Fair enough but when I think of a value stream analysis it is focused on what is best for the patient. So if we look at a value stream for uncomplicated low back pain, for example, we focus on the patient from start to finish — what is the patient pathway throughout? With a value stream analysis we can identify what steps are added value for patient and what steps are not — and then figure out a way to eliminate the steps that do not add value for the patient. In the traditional lean management approach the value stream is nearly always patient focused.
“It is Time for Clinicians to Engage: Let’s Criticize Less and Dare Greatly More”
I’ve learned a lot in life and one of the things I learned is when people want others to withhold criticism they generally have something to hide or they are trying to sell something.