I was reading a report recently called “Shifting the Dial” from the Australian Productivity Commission and it really resonated with my experience of the many challenges we face every day as clinicians.
How is it that we have 15% waste in our health services, expose many patients to “low value” procedures and have marked differences in cost and outcomes yet we seem incapable of improving this?
Let’s be clear – we caused it.
Maybe it’s because it’s hard to change rather than we don’t want to change. Maybe it’s because we are overwhelmingly organised to maintain the status quo.
Is this patient centred care or provider driven care?
Is it more about income than outcome? But what if better outcomes lead to better incomes?
I’m not criticising our intentions as clinicians but rather suggesting that it is the way we manage and prioritise healthcare that needs re-thinking. We should not be limited by old management paradigms and narrow thinking but allow ourselves to adopt more integrated and holistic approaches.
If we had asked 100 patients years ago after their knee arthroscopy for osteoarthritis how they went afterwards we would have known a few months later that it didn’t help them very much at all.
And as for the many other outcomes that matter to patients we still don’t measure or respond to them systematically. Our healthcare system in Australia is still playing catch-up to the idea of “value based care”. It seems strange that we don’t really value “value”.
Imagine if we measured our speed while driving by counting the number of speeding tickets in the letterbox when we got home? I know it sounds ridiculous but that is effectively what we do in healthcare. Information in healthcare tends to be fragmented and delayed. By the time we get information it often doesn’t help to improve the care we are providing today.
In our defence let’s say it would have been too hard to measure what matters to the knee arthroscopy patients with the technologies at the time – but the tech is no longer what’s holding us back.
Some healthcare providers can now demonstrate the ability to collect and combine data holistically, manage and show variation in cost and outcome for each patient and at a system-wide level in almost real time. This is not just impressive, it actually allows us to manage quite differently according to value. The providers that are embracing these new capabilities are finding new ways to compete on outcomes and make their business more profitable and sustainable.
We need to see patient experience clearly in relation to our actions; we need to be unafraid to publicly report on our safety and outcome measures; we need to integrate quality standards into our daily work as a continuous process for excellence and not just compliance. When these things are done it changes the very nature of conversations in our organisations to manage by both quality and cost in an efficient and sustainable way.
I think we have run out of excuses that prevent us from organising and managing what we all are here for – putting the patient at the centre of healthcare and delivering the outcomes that really matter to them.
Dr Chris Farmer
Clinical Director, Metrixcare