Bottom-Up Healthcare Reform

Good management is important, but it can’t create improvement

One of our major problems with healthcare reform is that we are doing it from the top down.

At the top, a bloated bureaucracy works in an environmental context of regulations and finance that seems to be focused on what is best for government and payers. The perils of out-of-control costs have forced the government to embrace the concepts of high quality/low-cost care, ideas that were hardly mentioned 10 years ago. A lot of change happens at the top, but to what effect? Can the government, in and of itself, improve healthcare quality? No.

One can argue that today's problems in healthcare began in Independence, Missouri, on Friday, July 30, 1965 when President Harry Truman signed the Medicare bill. On that same day, Truman was the first citizen to apply for a Medicare card. Ironically, he received his card one year later. And I would bet that he didn’t expect what was going to happen to healthcare during the next 50 years.

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Just curious...

Whose responsibility is it to be aware of and fix the all-too-typical experience of this patient -- from 20 years ago:

https://www.qualitydigest.com/IQedit/Images/Articles_and_Columns/Decemb…

All the front-line's "best intentions" in the world won't. When people tell me about their improvement successes, I ask them to read this and ask, "Could this still happen at your facility?" I usually get a sheepish "Yes." So, what's improved? Another point to consider: the front-line is treating the patient no better than they are being treated by management. It is a most non-trivial effort to set the front-line up for success -- you don't empower "clueless" (through no fault of their own) people! Just because someone thinks something is a "good idea" doesn't make it a good idea. Good management is important to set up an atmosphere where TRUE improvement can flourish.

Former President?

>> One can argue that today's problems in healthcare began in Independence, Missouri, on Friday, July 30, 1965 when President Harry Truman signed the Medicare bill.

Where was Lyndon Johnson when this was happening?

Some might find Henry Mintzberg's article on managing the myths of healthcare to be informative: http://www.mintzberg.org/sites/default/files/article/download/managing_…