American football is rich with statistics and advanced analytics meant to depict success in specific facets of the game. Once the dust settled after the New England Patriot’s breathtaking Super Bowl comeback against the Atlanta Falcons, I couldn’t help but draw parallels between healthcare—specifically, diabetes, also rich with metrics and indicators—and the approach of legendary football coach, Bill Belichick.
For years, patients with diabetes have relied on their glycated hemoglobin (HbA1c or hemoglobin A1c) levels to assess their success in managing their diabetes. An HbA1c score is known in the field as a steadfast indication of a person’s average plasma glucose concentration over a three-month period. This metric gives patients and their care team an idea of how well their blood sugar is being managed.
This approach, however, is being reconsidered as healthcare practitioners recognize that the goal of diabetes management should not be to obtain an ideal HbA1c score, but rather to reduce the risk of diabetes-related complications that have direct impact on patients’ day-to-day lives and long-term well-being. In fact, a recent study suggests that strict control of one’s HbA1c does not significantly impact one’s risk of diabetes-related complications.
What does this have to do with football? More than you might think. Now a seven-time Super Bowl champion, Belichick has voiced his distaste for overly detailed statistics being used to gauge player or team performance, and instead focuses on how well his players function as a single unit towards the ultimate goal of winning. His motto—“Do your job”—is echoed from his players on the field and in press conferences on a daily basis. He doesn’t ask any single player to win the game, but merely that they do their job, as placing too much significance on a single player’s role fails to recognize the larger picture and is likely to be deleterious toward the goal of winning.
His approach is instructive for success in sports, and can be equally instructive in the field of healthcare. A measure of how well one facet of care is being managed—like plasma-glucose—shouldn’t be used as a proxy metric for the ultimate, patient-centered goal of reducing disease-related complications. HbA1c scores must be measured and managed as a means towards an end, not as an end itself. Accumulating 300 passing yards can certainly help in the pursuit of a win, but achieving that metric is not in itself the ultimate measure of victory.
Healthcare stakeholders can prevent falling into the trap of false ends by ensuring that the ultimate outcome being measured is the progress patients are trying to make, given their medical circumstances. Just as the legendary Coach Belichick coordinates his team in a way that ensures each position understands their role as an important means to an end, caregivers must be able to focus their analysis of patient progress in a way that distinguishes the measures of achieving an end goal from the means by which that goal is achieved.
This recalibration towards patient progress and away from false ends holds potential, not just for one condition, but for healthcare as a whole. Imagine a value-based system where providers, insurers, and payment models work in unity toward a patient-centered goal. Now that’s a win we can all root for.
Ryan Marling is a research associate at the Clayton Christensen Institute for Disruptive Innovation.
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The Football Team Analogy can be expanded. We do not even rate the professional team level in health care because our teams are dysfunction. The players have constant changes of job descriptions. The management is bloated and communicates poorly with the team members. The players used to have greater influence, but this is missing. Unlike football, our health care management and coaches have not even played the game. Communications have broken down between players and management.
Even worse, the commissioner and staff control the purse strings. Regulation penalties from on high make it difficult to play to full potential. The commissioner forces the teams to buy equipment that is less than optimal. Productivity suffers. The media is fed mostly material about the problems of the players, not their accomplishments. The statistics are about the few losses and not the strings of wins. This makes it difficult for those who must buy tickets to trust the players when they most need to be trusted.
The changes have not been worked out and they have eaten into the productivity and process. The changes have impacted satisfying relationships with patients and other team members. It is no longer about playing the game, it is about the money.
There is so much done after the game that little can be done to prepare for the game. The players have to spend time after the fact to justify what they did and why it was not done cheaper. The players get little feedback about what happens after the game – at least to patients.
The players are not valued for their worth to the team, they are valued for how much money they generate which is also set by the commissioner. The commissioner sets payment not by player experience, but by the exclusiveness of the college attended. Orthopedic players with most exclusive training make as much as experienced orthopedists nearing retirement.
Payment is not set by the value to the team or to the patient. Those doing the long term day to day year after year duties are penalized. Those who spend a few minutes with patients and are most distant from patients in many ways are rewarded.
What is not apparent to the commissioners, management, coaches, or players is that the outcomes of the game are largely outside of their control. The outcomes are about the patient in the context of family, situations, behaviors, environments, community resources – especially lack thereof.
Focus on player errors, big data, quality measurement, digital interventions, managed playmaking, addressing high risk, or minimizing high cost has actually added to the cost of administration and care delivery leaving less for the players and team members. Some wonder why they played the game at all.
The commissioner keeps adding new corporations to feed and each past and present addition demands more dollars. The football team and players must share revenue with more entities, leaving less for those who play the game.
Attendance has always been low because half of Americans are too far from the game and tickets for care are too expensive. This also is a consequence of payments too low for the players that they most need (generalist, general specialties) who are fewest among developed nations and 3 times lower where most Americans are found.
Discount tickets are available but only a few and very difficult to find gates take these tickets and sometimes there is not even a game being played when you arrive. There is a ton of paperwork and other hassles required to get these tickets and if you do get in, there is even more specific care. In a fit of recent reform, many more discount tickets were handed out, but the access gates were not increased and were even more hidden.
Now all face the proposal to cut 20% of spending from the major source and most certainly there will be fewest gates and fewer who can participate. Children in most need of tickets are likely to suffer most along with those trying to escape poverty and the working poor.
Numerous societal funding changes will result in widening disparities and declining outcomes – no matter what anyone does from commissioner to player. This is because the outcomes are about what happens with people, communities and local resources – not what happens in the game. But the players will once again get much of the blame.