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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
Although I knew my job was to talk about the impact of physician behavior on quality and safety at an annual medical staff meeting and that the content needed approval to qualify for risk management credits, I also knew that spouses and significant others would be present. "Keep it upbeat, entertaining, and brief," counseled the medical staff president, who invited me to speak.
My wife looked horrified when I answered, "Whose mistakes will you discuss," with "Mine."
"You're kidding," she hoped. "Why would you want to do that?"
I felt honored to be asked to speak on mission-, vision-, and values-based business planning to approximately 100 physicians and allied healthcare professionals earlier this month. I summarized an article I had written in response to a chief operating officer who dismissed a practicing physician with an idea of how to shorten the time from presentation to diagnosis for patients with a prostate mass.
"Fine, now write me a business plan," the COO told the physician.
The physician did just that. Moreover, the business plan I helped him write became the blueprint for a multidisciplinary cancer center (Cohn KH, Schwartz RW. "Business plan writing for physicians." Am J Surg 2002;184(2):114-120).
With that in mind, I gave the audience of physicians and healthcare professionals four principal reasons to write a business plan:
Autumn in New England seems like a fitting metaphor for healthcare reform, in that it requires us to let go of the past and prepare for an uncertain future.
Recently, I spoke to the Physician CEO Healthcare Roundtable on "Healthcare: What's Next." To deal with my uncertainty, I used Prof. Michael Porter's Framework1, which states that healthcare organizations must meet seven different conditions to move from a volume-based to a more value-based healthcare system.
"We face a serious dilemma," recounted a community hospital CEO who participated in my seminar, Practical Strategies for Engaging Physicians. "If we stop doing fee for service now, it will cost us millions of dollars. On the other hand, if we wait, the trap door may close behind us. We need to be ready to flip the switch."
All the other CEOs in the room nodded their heads.
The fundamental challenge in the transformation of U.S. healthcare from volume to more value-based metrics is readiness in an uncertain environment. As I've noted, "complex adaptive systems involve a collection of people acting interdependently, such that one group's response changes the context for everyone else."1
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