BOSTON -- In the face of mounting health care costs, declining quality of care, and an explosion of need, nations around the world are debating how to "fix" their health care systems. Most common solutions have focused on how to fund and reimburse health care, but physician and Harvard Business School senior lecturer Richard Bohmer argues that this focus misses an important piece of the problem. Rather than solely determining how to better fund health care, we must also understand the fundamental nature of care and ask how we could better design, manage, and deliver it.
In his new book, Designing Care: Aligning the Nature and Management of Health Care (Harvard Business Press), Dr. Bohmer asserts that health care is essentially a process of applying the best available medical knowledge - both research and clinical - to solve patients' health problems. In recent decades, the knowledge that underpins care has dramatically increased in volume and sharpened in specificity, enabling some treatments to become standardized while others remain highly uncertain. Carrying out these very different types of care processes requires different management systems, resources, tools, and personnel; yet most health care organizations are not set up to do this. The result has been a misalignment between patients' health problems and the processes and treatments applied to solve them.
Integrating Dr. Bohmer's experience in both medical science and management practice, Designing Care outlines an approach to health care design and management that enables organizations to deliver proven medical treatments more effectively, and capture valuable clinical learning while treating more ambiguous health problems. In this book, Dr. Bohmer develops an approach to health care delivery that is grounded in the nature of the work required to care for an individual patient suffering from disease.
Through stories and cases drawn from health care institutions in multinational settings, Dr. Bohmer reveals how health care providers can successfully manage both modes, outlining what organizations look like in practice when "care delivery" and "learning from care" are combined. He describes the six key organizational capabilities required to simultaneously implement best practices for well-understood health issues, create the new knowledge required to solve complex health problems, and embed that knowledge into
next-generation clinical practice:
- Operating capability: Internally aligned operating system configured to meet the needs of the target population (externally aligned),
- Performance measurement: Balance of process and outcome measures,
- Production control: Financial and nonfinancial incentives and sanctions that influence provider behavior,
- Anomaly detection: Supportive culture and multiple methods capable of detecting signals of varying strengths,
- Analysis: Quantitative and quantities analysis of small and large data sets and multiple experimental methods (hypothesis generating and hypothesis confirming),
- Adjustment and redesign: Short-term response to individual problems and long-term operating system redesign.
About the Author
Dr. Richard M.J. Bohmer, MBChB, MPH, is a New Zealand-trained physician on the faculty of Harvard Business School. He graduated from the Auckland University School of Medicine and has practiced hospital and primary medicine in New Zealand and England. In 1989 he was part of a clinical team that established and ran a surgical hospital in the Sudan. He attended the Harvard School of Public Health on a Fulbright Scholarship, graduating in 1993 with a Masters of Public Health in Health Care Management, and joined the HBS faculty in 1997.
At Harvard Business School he teaches an MBA course on health care operations management, co-directs the MD-MBA program, and is the faculty chair for two executive programs in health care delivery. He teaches and consults on health management issues in numerous locations around the world. Before joining the HBS faculty, Dr. Bohmer was the Clinical Director of Quality Improvement at Massachusetts General Hospital, where he was responsible for planning and implementing the clinical quality improvement program.
In October, Dr. Bohmer
will lead a new Harvard
Business School Executive
Education program for
Dr. Bohmer's research focuses on the intersection between medical care and management practice and
concentrates on understanding how best to design and manage the process of patient care in order to improve
clinical outcomes. He has published in both the management and medical literatures on learning, technology adoption and operations strategy in
health care, and on quality improvement and patient safety.