Saturday, September 05, 2009

“Interfering” in Clinical Practice

Eugene Litvak, professor of health care management at Boston University, has made a name for himself by becoming an expert in the way patients move through hospitals and by showing hospitals how they can become more efficient by improving that movement.

His story was the subject of an article in The Boston Globe that appeared on August 30, 2009 under the byline of veteran health reporter Scott Allen.

Late in the article, reporter Allen suggested two reasons why hospitals were so late in adopting Litvak’s approach, which is commonplace in other types of work. The first was that their monopolistic status meant that they didn’t have to. The second was that doctors and nurses are oriented to helping people, not to efficiency.

There is a third reason that Allen missed. The culture of health care has drawn a hard line between management and clinical practice. Managers were supposed to deal with non-clinical matters like finance and facilities while doctors, nurses, and other health professionals looked after the clinical functions of caring for patients, activities that managers were to stay out of. No manager interested in job security would want to be accused of “interfering” in clinical matters.

There being no way to apply established management practices to patient flow or other clinical processes without “interfering” in what the professionals do, those aspects of patient care have in general not been subjected to “management” as that term is generally understood.

Economic and other pressures are causing that to change, if ever so slowly. For reasons only lightly explored in the article, Professor LItvak has managed to become engaged in activities that heretofore have been off-limits to non-clinical “outsiders.”

Those seriously interested in reforming the cost of health care ought to study Professor Litvak’s work in order to learn how to go about expanding the sort of work he is doing.

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