Blog | Tuesday, October 16, 2012

Waste not in health care


In some ways, the Institute of Medicine is like the famed "Academy" of Motion Picture Arts & Sciences. Having membership conferred is the ultimate accolade in a field full of brains, competition, money, and ego. A major difference is that the IOM doesn't give out annual awards for best studies or best theories. The whole institute is comprised of lifetime achievement award winners.

That's why when the IOM issues a report, it garners a lot of attention.

Their most recent, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America" attracted the usual spate of headlines:
"Health System in US plagued by $765 Billion in Waste"
"How Broken is US Health Care? Let's Count the Ways"
"US Healthcare Needs Revamp, IOM Says"

I've looked over the report. It's been released in 'pre-publication' form on their website, and you can read the whole thing. It's a worth a click over, because even if you can't slog through 350+ pages, they've made several executive summary features (including a top ten list) and graphics that do a great job of conveying the authors' findings and recommendations. A few things jumped out at me:
--$750 billion of our collective annual $2.3 trillion health care outlay does not improve health,
--we still have far too many errors in hospitals,
--too many patients discharged from hospitals are readmitted in less than a month (20%!),
--which points to the lousy job we do 'transitioning' people from hospital to home, and
--communication among medical personnel is abysmal.

The report uses analogies from many industries. There's the requisite comparison to aviation, since the safety record of commercial airlines is enviable. But there are also comparisons to hotels, manufacturing, general contractors, engineers, and even "mission control" at NASA. [Health care does not compare favorably to NASA. Doctors should, but are not working for a common purpose like getting people to the moon.]

The report notes that health care as an industry needs better methods of absorbing the profusion of new knowledge that is generated, and implementing effective practices and therapies more quickly, broadly and uniformly (say, like, the Cheesecake Factory?).

Two other observations, that got no press as far as I can tell.

There's an appendix to the report (appendix B, if you're keeping score) called "A CEO Checklist on High Value Care" that's derived from a roundtable of CEOs from some of the most highly regarded health systems in the U.S. In it, they share examples of best practices and compact with one another to strive for collective excellence. Never mind that they are all (in a sense) competitors. It's smart marketing and effective use of peer pressure to the good–no one wants to be left out of this exclusive group.

Lastly, the report includes an
aspirational challenge in its recommendations (#5 on the top ten list) that I was very pleased to see: "Community Links." That is, if we improve our system in the ways that are suggested by the IOM, it will only get us so far if all of the best practices are locked in ivory towers and not disseminated into our communities. It's high time that august bodies like that National Institutes of Health and the IOM have begun to insist on this.

Anyone out there know of any schools that are moving in this direction?

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.