While others weigh the pros and cons of the Affordable Care Act, HBS faculty are studying healthcare delivery on multiple dimensions. Here are three perspectives from faculty members Robert Huckman, Deepak Malhotra and Anita Tucker.
16 OCT 2013: The New England Journal of Medicine
BY: Robert Huckman
Several forces in the United States — including the Affordable Care Act (ACA) of 2010 — have promoted greater public reporting of health care outcomes. By many accounts, this reporting is largely ignored by consumers (see graphConsumers' Access to and Use of Data Comparing Quality of Health Care, 1996–2008.),1 perhaps because the information is hard to find or difficult to understand. We propose another potential explanation — namely, that the public spotlight is not aimed at information that most patients value.
Current public reports typically compare health care providers in terms of quality or cost to help consumers decide where or from whom to seek care. For example, patients in New York and Pennsylvania can view the cardiac-surgery outcomes for specific surgeons and hospitals. Such reporting assumes that patients have already decided to pursue cardiac surgery and are using this information simply to select the best provider. Unfortunately, this information does little to help patients decide whether they want or need surgery in the first place.
21 OCT 2013: HBR Blogs
BY: Deepak Malhotra and Manu Malhotra
A 54-year-old man presents to the Emergency Department (ED) with crushing chest pain and is found to have an ST-elevation myocardial infarction (heart attack). The patient needs a heart catheterization with likely stent placement, but he insists on leaving the ED. The emergency physician is unable to convince him otherwise despite confirming that he understands the risks and consequences of his decision. He leaves and returns via ambulance several hours later in cardiac arrest. Could this story have ended differently? Quite possibly, yes. But not with skills that are taught in medical school. Now consider a host of other conflicts: from interdepartmental turf wars, to poorly designed agreements between hospital systems and insurance providers, to the difficulties encountered in aligning hospital goals and incentives with those of contracted physician groups. In these and many other interfaces within our health care system, the limitation is neither incompetence nor ill intent, but rather a dearth of negotiation skills and acumen.
Negotiation is the process by which two or more parties with different interests or perspectives attempt to reach agreement. The domains in which negotiation is relevant can vary widely. We might negotiate business transactions, international agreements, marital disputes, or just about any kind of conflict. Regardless of the context, however, negotiation is fundamentally about human interaction. Whether we are discussing money, terms of peace, spousal relations, or healthcare policy, the fundamental question that negotiation theory helps us tackle is this: how might we engage with others in a way that yields better outcomes and understandings? As anyone involved in the health care system knows, hospitals and health professionals are faced with this question every day.
16 OCT 2013: HBR Blogs
BY: Anita Tucker
It is widely acknowledged that patients and their families should be deeply involved in the design of and decisions about the health care that the former receive — and that it is integral to achieving high quality and patient satisfaction. But delivering such “patient-centered care” has proven challenging. After hundreds of hours of observations in hospitals throughout the U.S. and Canada, I have come to the conclusion that health care professionals will continue to struggle to deliver it unless hospitals redesign their internal supply processes, structures, and measurement systems so that staff have the specific materials and equipment needed for patients’ individual care plans, when they are needed. The good news is that approaches in other industries offer possible models for hospitals and other care providers.
My research shows that problems with the supply of equipment and materials — which I call “operational failures” — disrupt care and waste up to 10% of nurses’ workdays. On one medical/surgical nursing unit I observed, there was a chronic shortage of functioning computers-on-wheels, which connect to the network and enable doctors and nurses to access patients’ medical information and to enter notes about care delivery. The shortage motivated some nurses to arrive 30 minutes before their shifts to secure computers for themselves. They did this by making the computer appear broken or by putting personal possessions on it to deter other nurses from using the device.
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