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Physician engagement can cut waste

February 12th, 2014

by Kenneth H. Cohn

Patrick Bresette of the national think tank Demos wrote that cutting waste increases public confidence in those who do so. Dealing with wasted money in healthcare is tricky because it is marbleized rather than something we trim with a meat cleaver.

Sources of waste include:1, 2

  • Duplicative of testing
  • Inventory
  • Arbitrary variation
  • Wait time
  • Errors in diagnosis, therapy and communication
  • Looking for supplies
  • Fraud
  • Working at the low end of one's skill set


All of these areas are within the purview of physicians to influence. For example, orthopedic surgeons at a California community teaching hospital agreed to standardize their technique and consolidate vendors, saving the hospital more than $5 million3.

Through the process of healthy competition, cardiologists at a Connecticut hospital came to consensus on cardiac catheterization procedures when they ran out of space for equipment and supplies for six independent practitioners4. As a member of the group told me, "None of us wanted to be an outlier, except on the positive side."

In Charting the Course5, an embattled CEO said to his chief financial officer, "The front lines can find the 50 percent waste in our hospital faster than you ever could." What we need now is physicians and nurses working more closely with CFOs, so the front lines can understand the system implications of their daily decision making and CFOs can become more strategic rather than reactive in their thinking.

In a hospital in Idaho, a CFO rounds on the floors. She engages clinical colleagues with open-ended questions, such as "What wastes your time?" and "Please tell me about times when you felt patient care was compromised because you did not have adequately functioning equipment and supplies."

Collaboration as described in the above examples gives me hope. What gives you hope that, despite the messiness of being in the middle of healthcare transformation, we will arrive at a leaner, more aligned, focused, patient-centered healthcare delivery system?

1 Kelley, R. "Where can $700 billion in waste be cut annually from the US healthcare system?" Thomson Reuters Waste White Paper. 2009.

2 Brook, R.H. "The role of physicians in controlling medical costs and reducing waste."JAMA. 2011.

3 Cohn, K.H., and Allyn, T.R. "Cultural transformation from the ground up: Being part of something larger than yourself." Ignite Your Business: Transform Your World. Orlando: Celebrity Press, 2010.

4 Cohn, K.H. Better Communication for Better Care: Mastering Physician-Administrator Collaboration. Chicago, Health Administration Press, 2005.

5 Nance J, Bartholomew K.M. Charting the Course. Bozeman: Second River Healthcare Press, 2012.

Ken is a practicing general surgeon/MBA and CEO of, who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance.


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