Monday, June 20, 2011

Root Cause of Health Care Crisis?

By Pascal Dennis,

Health Care is a disaster North & South of the border.

Neither Americans, nor Canadians can look on their situation with any satisfaction.

Costs are exploding -- and crowding out other critical expenditures like education, R & D and infrastructure.
Health care outcomes are disappointing. Miracles occur within the silos, catastrophe across them.

What's the root cause of this sorry state of affairs?

Why can't smart, skilled and caring medical professionals do what they're trying to do?

Deming taught us that the problem is in the system -- and he's right again.

Mis-medication, wrong site surgery, infection and other nosocomial calamities occur despite the heroics of nurses, doctors, pharmacists and the many other specialists who keep hospitals going. Indeed, things would likely be much worse but for their heroics.

So what's the root cause of our health care crisis?

Tom Papas, the protagonist of the business novel, The Remedy, tries to answer this question in chapter 13.

He is in rough shape -- he might be losing his father to a mis-medication.

Tom's conclusion: the customer is not the customer.

Only patients, he concludes, can arbitrate the millions of daily decisions that comprise the provision of medical care.

Yet the patient is not the customer in these transactions.

As evidence he reflects on how difficult it has been for his family to get Safety, Quality or Cost information from hospitals.

"And why should they give me info?" he laments. "I'm not the customer."

I've gotten a lot of mail about this chapter!

So what do ya'll think? Is Tom right, or is he not thinking clearly because of his desperate situation?

Are there other root causes that are more important? Any other thoughts or insights?

I'd be pleased to hear from you.


  1. I don't think there is 1 reason why the health care system is so bad in the USA. If I had to pick the most important reason it is the legal infrastructure. The system is designed (with legal constraints) to favor entrenched interests instead of customers and stakeholders.

    It is true other rich countries also have massive room for improvement. But the USA stands far below all other rich countries. The costs in the USA are about double the average rich country. And the heath care outcomes are mediocre. And the economic and personal outcomes are extremely bad. Tying health insurance to an employer is an extremely bad idea - that is rare among rich countries (I am not sure if the USA is unique in this bad practice, or not).

    I have many posts on the problems on USA health care and how to improve the health care system.

    It is possible to try and find the common reasons for health care failures in the USA and other rich countries but the USA is really in its own class of badness.

  2. Systems are complicated and messy by their nature and Health Care certainly fits the bill. Systems are also heavily inter-connected and have a clearly defined purpose. I don't think the purpose of the Health Care system is clearly defined. Is it to help people get beter one they are sick or is it to promote overall health and well being of the population?
    Without a clearly articulated purpose, it becomes everything to everyone and ends up sub-optimizing at best.

  3. Good comments, John & Al.

    John, I look forward to checking out your posts -- thanks for sharing.

    The more complex, foggy, tangled the situation the more we need to default to the fundamentals

    To wit, gain alignment on a) the system's purpose, b)the best set of activities (programs) to achieve that purpose, and c) how to check & adjust outcomes & activities (governance).

    As you've both said, there is neither alignment on purpose, program mix, nor governance.

    A tangled web indeed. Reminds me of the mythical Gordion Knot.

    Do we have an Alexander to cut through it?

  4. Hi all,

    That last comment was by yours truly



  5. Andre DeMerchantJune 22, 2011 at 3:19 PM

    Interesting to me is how everyone on the 'outside' generally agrees that there are system issues as well as a missing definition of purpose while the closer you get to centre the less it seems people are willing to admit this is the case. Or so it seems. This lack of problem consciousness will continue to foster the inertia that we see in evidence and so nothing gets improved/resolved. Having lived on both sides of the border I have experienced both health care systems and although both are broken at least the US system seems weighted in favour of preventative care---probably because the insurance companies realize there is a greater cost for NOT doing that---v.s. the Canadian health care process that is more reactive and serves nobody well. So how do we get these broken, yet desperately needed, systems to the point where they realize that they themselves are ill? And how can we help the patient cure himself?

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