Building a Better Delivery System A New Engineering/Health Care Partnership (2005) / Chapter Skim
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Barriers and Incentives to Change
Barriers and Incentives to Change
Pages 225-240
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Barriers and Incentives to Change
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From page 227... ...
The group decided to focus on process meathe federal government can run such an effective, popular sures rather than outcomes, which would be more controverprogram, it could also lead the charge to reengineer health sial. According to the clinicians who worked on the study, care delivery systems to promote better quality of care.
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From page 228... ...
The day after the data were group of mediocre hospitals that were threatened by the noreleased, the New Jersey Medical Society held a press con- tion of providing information about outcomes and quality ference. Surprisingly, the physicians at the press conference and offering beneficiaries incentives to choose higher qualdid not question the data or criticize HCFA (a popular pas- ity care.
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From page 229... ...
For these reasons, I think we need to be realistic skeptical that this would be allowed -- or for that matter, se- about how difficult reengineering health care delivery sysriously attempted by any administration. The Clinton admin- tems will be and how difficult it will be for the government istration did make some efforts in this direction, but it was to play a leadership role.
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From page 231... ...
A risk mitigation plan itself can have risks because it proErrors in risk mitigation come from three areas: agency risk, vides a sense that risk has been addressed. If you haven't risk migration, and risk degradation.
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From page 232... ...
dustrial disasters and major financial disasters have shown That is the only way you can control agency risk. Real-time that over time there is a gradual degradation of the risk man- audits often reveal degradation in the risk management proagement process because systems are not maintained and cesses.
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From page 233... ...
tional rates of quality failure and the IOM reports, they re- Another approach would be to use systems analysis to ply, "We don't believe that our personal error rates are as identify narrow, high-yield single "ingredients" (e.g., uptake bad as the national average. To achieve perfect care, we'd of electronic clinical information systems or implementation probably have to hire quality engineers and buy complex of robust disease registries to provide continuous, stratified clinical information systems.
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From page 234... ...
Besides purchaser-mediated rewards, purchasers can ap- Let me close by briefly addressing a pivotal engineering ply engineering principles to their own purchasing processes. challenge for all institutional stakeholders -- the need for conIn the world of health care purchasing, there is no clear con- sumers and physicians to recognize the magnitude of current sensus on intermediate outcomes or the best way to pursue quality failure in health care in their own work.
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From page 235... ...
1This report does not necessarily reflect the view of the Federal Energy Small, unwritten rules matter. In New Zealand, unwritten Regulatory Commission.
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A number of staff at the Bad incentives yield bad practice. Enron is a case in point Federal Energy Regulatory Commission noted that the model in the energy market.
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From page 237... ...
By the 1920s, ing lists didn't move, and on the tenth day bad things interns had become a significant part of the labor force in happened. The student might have accepted his third-choice hospitals; and internships had become an important part of offer and then, later in the day, received a more preferred the career path of doctors.
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From page 238... ...
when we call the two residency programs in New York, they The surprising thing that was observed in the 1950s is may be happy to take us, which now leaves the Boston jobs that most positions were filled as matched: that is, students unfilled and some people who were matched to the New and residency programs submitted their rank order lists and York jobs scrambling to find new ones. then went on to sign the employment contracts suggested by So, a failure to elicit the right kind of information (the the match.
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From page 239... ...
There are waiting lists, with priorities based on crite- tion, and what information is delivered depends on how that ria such as time on the list and current health. information will be used.
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