3 Reasons the General Public Doesn’t Think Healthcare Can Improve

Mark Graban

Lean thinkers see the waste in healthcare when they are at the hospital “gemba“. I think this is true whether you are a Lean person who is new to healthcare or if you’re a long-time hospital person who has learned Lean. Experts (doctors) ranging from John Toussaint to Patricia Gabow to Don Berwick all estimate that between 30 to 50% of healthcare spending is waste.

It seems that, often, when you take this sort of discussion to the general public, people react emotionally as if “reducing waste” equates to not providing people the care they deserve – they think Lean healthcare is about taking away, instead of reducing cost and improving quality. I think this happens even outside of charged political circles. Why is that? I have a theory.

Some of the common waste is described in this article about a new Master’s Degree program at Dartmouth:

Disney knows precisely how to gauge the wait for rides at its theme parks.

Major airlines know how to maintain near-perfect safety records on their aircraft.

But hospitals? Most don’t know how to avoid making patients wait — some just build bigger waiting rooms.

Medical centers spend increasing amounts of money on patients, but don’t necessarily deliver better care.

And estimates suggest that each year in the United States there are 15 million incidents of medical harm, some of which result in injury or death.

Now, a new master’s degree program at Dartmouth College is intended to bring more of the business of safety, cost-effectiveness, and efficiency into medicine

My theory is that the general public puts a lot of faith in our healthcare system – blame TV or the movies, I guess. Would they think that a program like Dartmouth’s is even needed?

I think people find it hard to believe the 30 to 50% waste estimates because they assume healthcare is fundamentally pretty perfect, or that it should be.

It breaks down into three categories… because we have the following, we should already have perfect waste-free healthcare delivery:

  1. We have highly trained, motivated people who care a great deal about patients
  2. We have relatively new, modern hospital buildings
  3. We have amazing healthcare technology (equipment, software, and medical knowledge)

So what could go wrong, given those three things? Yet, Lean thinkers know the overall system just doesn’t work. I think it’s hard for the general public to see that 1+2+3 = a lot of waste when they would likely assume 1+2+3 = awesome.

So when errors occur, the general public wants to blame and punish individuals – assuming they must be bad people working in an awesome system. When cost is high, people want to blame the greedy or the incompetent. People don’t tend to look at the overall system, they wouldn’t expect the problem is bad processes, not bad people. The general public assumes quality is good, when the data show otherwise.

It’s safe to say there are indeed a lot of great things about modern healthcare (see 1, 2, and 3, above). But we don’t get the high quality and patient safety we deserve and we, in America, certainly spend way more than we have to — and this high spending is partly due to waste, not due to 1, 2, and 3.

Do you think the public shares that perspective that I described above? Does that common (and arguably incorrect) view get in the way of the public calling for real systemic improvement that reduces cost and improves quality/safety? If so, how can we change that perception that 1+2+3 automatically equals awesome?

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One Response to 3 Reasons the General Public Doesn’t Think Healthcare Can Improve

  1. Mark,

    Excellent analysis of the situation. Yes, a degree in this is required if you spend any amount of time in a hospital. The largest part of the curriculum should be how to avoid insular, cottage industry thinking about a multi-million dollar revenue facility.

    I think the public does share the perspective you’ve shared. Not only that 1, 2 and 3 are the best the world has to provide but that the process is broken. Unfortunately, the focus on the Healthcare debate is on paying for it: taxes, individuals, evil insurance companies, etc. The focus could and should only be on Cost. We are beginning work with a couple of major hospitals that are attempting to address this very issue. They are the early adopters of what I hope becomes an industry wide effort. For the amount of money that ObamaCare wants to spend in 1 year the entire industry could be updated and costs eliminated by the 30 – 50%.

    The process of a hospital is a series of disjointed starts and stops. In a recent discussion regarding Chemotherapy I came to understand that patients, who are already in perhaps the most difficult time of their life, have to show up the day of their treatment with no idea when they will be in and out. First there is the gathering of patient information followed by waiting. Then the gathered information is “tabulated” followed by more waiting. Then the pharmacy has to build their treatment…more waiting. But now that the pharmacy is done, you have 15 minutes to begin administering the treatment or the treatment itself becomes fatal. You bill out the “cost of the treatment” chair on a ridiculously small pool of sick, patient patients.

    Process controls, insuring first quality, second productivity and third throughput/comfort/satisfaction, are essential in truly addressing the Healthcare crisis. Trillions in taxes and further government intervention isn’t the solution.

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