Tuesday, December 02, 2008

Bottom Up and Inside Out

An alleged pneumonia together with the aftermath of a small, silent heart attack recently won me four Medicare-subsidized nights in South Shore Hospital in Weymouth, MA and two more in Boston University Medical Center in Boston.

I’ve been a hospital patient twice before, but what struck me this time was the mind-boggling complexity of it all. Hospital operations consist of unnumbered large and small functions performed in constantly varying circumstances and each related in some way to every other. As a result, if one of those functions is changed, nobody can be smart enough to predict or understand what the effect of that change will be in other parts of the organization.

What that tells me is that it is not wise to try to reform a hospital’s operation from the outside or from the top by picking particular things that look inefficient and then telling the hospital how to change them. The changes thus prescribed are likely as not to create even greater problems elsewhere in the organization.

Pressuring hospitals during recent years to make more use of information technology (IT) illustrates the point. Responding to that pressure, hospitals have undertaken to implement particular applications, only to find that doing so raises havoc elsewhere in the operation. Patches are applied, which turn out to have unexpected consequences of their own. Budgets and schedules go out the window. Sometimes the whole effort is abandoned.

No doubt the millions upon hundreds of millions that have been spent implementing IT in hospitals will ultimately prove beneficial, but the cost has been horrendous.

Hospitals shouldn’t be pressed to implement IT. They should be expected to improve their quality and reduce their cost and to learn how the potentially powerful tool of IT might help them do it.

The lesson here is that anyone who is serious about reforming health care operations should recognize that it is best done from the bottom up and from the inside out.

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