The time for change is now: A revolutionary approach to healthcare
By Bill Bysinger, for Healthleaders.com, March 13, 2002
I have been silent for the last few months observing what is taking place in healthcare regarding change. I have been disappointed.
I am also amazed that most of the response to articles I write about change in healthcare comes from vendors who are trying to tell me their latest "XYZ software or service" will make what I say happen.
I have finally come to the realization that it is not technology, HIPAA, ehealth, or any other single factor that will make healthcare better, only healthcare itself and those who participate in it are capable of making it better.
For those of you old enough to remember POGO in the comics, we have met the enemy and they are us.
The change needs to take place among payers, providers, vendors, and associations.
The key to real change is the delivery of care in the hands of the providers. In order for this to work, payers must not be the adversaries of providers but the enablers of better healthcare by making information available to providers and reimbursing providers on a timely basis (days, not weeks or months). Get out of the float process and pay on time.
In order for change to happen the following needs to take place among providers:
Healthcare has to admit that it is a business.
Then a vision of what the most efficient model for the healthcare business to operate in must be defined. (Paint the Future)
As a business it must have a plan. (Measurable, Time Dependant, Achievable)
Physician practices should have a sound business plan
Hospitals should have a sound business plan
Medical Groups should have a sound business plan
Clinics and ancillaries should have a sound business plan
These plans should address:
*Profitability (no longer a dirty word unless everyone is willing to work for free)
*Projected investments for growth and change
Healthcare management decision makers have to make sound business decisions that will effect change.
These decisions have to have measurements specified to gauge the effectiveness of the change.
All investment decisions must have a sound project methodology to make sure that the change invested in will accommodate success through timely implementation.
All decisions must be tied to results that are defined in the business plan.
Healthcare is not unique. There are customers (patients/employers), there are services (treatment/encounters), there is money exchanged for services rendered (claims/reimbursement), and there are suppose to be measurable results from services rendered (wellness/protocols leading to wellness).
This is what must be. Here is what I currently see and hear.
1.We are different.
2.We don't have time to plan.
This is a self-fulfilling prophecy, no time to plan, never plan,
and never succeed. We have policies and procedures
3. Only delivered in education when someone joins the organization. After a year these become folklore and fairytale. HIPAA is government intervention and we don't have time to do it.
4. It is really about change and standardization that will result in cost effectiveness and efficiency.
5. We have no money to do anything.
Then why do you stay in business?
6. We cannot justify doing that.
Would you rather stay in the old ways forever?
7. Only the big organizations can afford to make change.
Why do we think bigger organizations cost less or have more time to do the right thing.
8. We blew it on a project a year or two ago and I have no confidence we can do a project to make change happen again.
Not everything succeeds, although failures usually turn up a systemic problem such as lack of project management, no clear objectives, no clear communication channels for problem mitigation, or no measurements to make sure success happens.
9. We can only devote investment dollars to the places that give us the greatest return immediately.
This way only the rich get well and everyone else suffers forever. This is a metaphor for always feeding the most successful financial programs and never allowing other departments or programs the opportunities to succeed.
10. We need to cut more staff since they are the most expensive assets we have.
Here is the healthcare problem that has haunted the industry for the last 10-15 years. It is easier to cut staff than make good business decisions about investing in efficiency.
11. We get good compliance scores every year so were OK.
This has nothing to do with healthcare efficiency and cost effective business management.
Most healthcare organizations remind me of the company that thought their products were so good they couldn't lose because they won all the awards even though they could not make sales and every sale they made they lost money. Before you know it they are out of business. Sound like someone in the news lately (Enron and Global Crossing).
We are at the mercy of the payers. They reimburse slow and hold us to low fees.
What if programs could be built to take the slow paying payers out of the equation? Would that help?
So when will change happen in healthcare and what do we have to do?
Stop playing the denial game. There is no choice, change must happen.
Step up to change and make better investment decisions Simple scenario is to implement HIPAA.Why?
*Standardizes healthcare information for faster claims processing, better patient information, and ultimately better care due to more informed decisions based on patient information.
*Patient confidentiality is real and must be accommodated. If not, you will be sued - plain and simple.
*Security is something that should have been there forever and it is a crime that it has not been implemented well in an industry that is based on privacy.
*Make the tough decisions to improve processes and update policies.
*Look at your internal processes and see how much real duplication of effort is in the way of clinicians every day based on too much paper.
*Take on eHealth. (The digitization and securing of information for faster distribution throughout the continuum of care both internal and external)
*Listen to your customers- the patients - about their experiences with your organization. Do not dismiss as complainers or exceptions.
*Move off of old, antiquated, difficult to use, inadequate systems and move to easier to use, intuitive systems.
*Create good project teams and a project management discipline in the organization to measure effectiveness and success.
*Embrace change and make it happen.
Healthcare as an industry is inefficient, costly, and frustrating for both the participants and the customers. It is time to make change happen.
I have been writing articles about healthcare change since 1994 and I have seen little change. Everyone goes to seminars on it, articles are written about it.
Don't get me wrong. Pockets of good practice and change are happening in the U.S. healthcare industry. Unfortunately, they are too few and far between. As well, these groups who are effecting change are normally mega organizations or rural healthcare groups; the majority are still far from doing the right thing.
Visionary leadership is still not predominant in healthcare and taking risk on creating change is not the strong suite of most healthcare organizations. It does not take a lot of money or a big consulting partner to make change happen. It can be done on the grass-roots level by challenging the staff and giving them the latitude to make change happen. Listen to those who deliver the care every day, they know what problems there are and they can create thoughts for change.
I challenge every healthcare institution, organization, group, HMO, or payer to make change happen within his or her area and let's shoot for a real change in healthcare over the next few years. Not like the one I have been waiting to see since 1994 that has yet to materialize.
As usual I have probably said things that offend all or part of every facet of healthcare, but much of what I say I hear others say, just not in public. It is time to go public. We are broken and we need to get fixed.
I only do this because I am passionate about healthcare and the healthcare industry. It is the most important part of our American experience and we need to get better at it.
Bill Bysinger has spent the last eight years heavily involved in administrative and clinical systems for healthcare networks as well as the HIPAA legislative process. You may contact Bill at (360) 981-0173 or by e-mail at firstname.lastname@example.org