What not How

The hospital journals are full of talk about computerizing medical records, reflecting the scramble for the incentive money included in the recently enacted health care reform legislation.

It reminds me of a lesson I learned early in my administrative career.

My boss thought that the daily close-out procedure being used by the cafeteria cashiers was too cumbersome and asked me to design a better one, which I proceeded to do.

A couple of months later, he suggested that I go back and see how my procedure was working out. What I learned was that the cashiers were now carrying out both procedures; the one I designed because I told them to and the old one because they understood and trusted it.

The lesson was that in situations involving complexity, it is better to tell people what you want them to do and give them whatever help they need to figure out how to do it.

Our system of health care, infinitely complex and bound up in culture and tradition, follows many practices that are antiquated and inefficient. As was the case with me as a young administrator, the first impulse of politicians and experts is to prescribe the solution. The result is often the same as it was with me – instead of improving the situation, they make it worse.

What is going on is that hospitals and other health care institutions are implementing computer technology (at considerable expense) in order to get the federal money and the favorable publicity that goes with it, while continuing to do their work in the same old-fashioned, costly way.

The better course would be to put pressure on them to get their costs down and their quality up.

Then leave it to them to figure out how to do it.