A Time for Revolutionary Thinking: Three Things Clinicians Can Do to Shape the Debate on Healthcare Reform
Lord William Beveridge, a prominent British economist, once said “a revolutionary moment in the world’s history is a time for revolutions, not for patching.” There is ample evidence to suggest that healthcare in the United States has reached such a moment. We are being overwhelmed by complexity, the incidence of avoidable harm is too high, quality is too inconsistent, costs are out of control, and waste is widespread.
We need to design a system of healthcare that optimally meets the country’s needs while also being affordable and socially acceptable. Clinicians should be at the center of this debate if care delivery is to be designed in a way that puts quality of care before financial gain.
This challenge is too important to be left to politicians and policymakers. There is an urgent need for clinicians to step up, lead the debate and design a new future for healthcare. Placing professional responsibility for health outcomes in the hands of clinicians, rather than bureaucrats or insurance companies with vested interests, must be an ambition for all of us. We need to find the formula that meets the needs of the patients and communities we serve. A sincere collective effort by committed clinicians to design an effective system will lead to a healthcare system that has a democratic mandate and the appropriate focus on optimizing the outcomes patients and society need.
As clinicians enter the debate, they should keep three things in mind.
Promote the leadership role of clinicians
We need to help politicians and policymakers recognize the role of clinical leaders in shaping a transformed but effective healthcare system. Clinicians must redefine the debate so that it focuses first and foremost on patients and health outcomes. Cost effective care can and should be a byproduct of optimal care. Accomplishing this will provide a strong common purpose for efforts to address the challenges of designing outcome-based funding structures and improving access to care.
Explain appropriate levels of care
Clinicians must inform both policymakers and the wider public about appropriate levels of care and the appropriate venues of care. A disproportionate focus on the treatment of acute illness and injury, which consumes by far the most resources, will not serve our country well. Primary care accounts for most of the healthcare that is delivered in the United States. There are nearly 1 billion visits made to physicians’ offices every year in the United States, but there are fewer than 40 million hospital stays. We need to pursue every opportunity to direct care to the lowest cost venue of care that can effectively address a patient’s needs.
Adopt a data-driven approach to care
Any system must be driven by data, focused on outcomes, and designed to deliver the appropriate level and type of care. The current hospital-centric, overly referral-based system often leads to unnecessary referrals and an over reliance on the most expensive diagnostic tests and treatments. It also ignores other major determinants of health. Health problems related to lifestyle, such as obesity, smoking, substance abuse, and diabetes will not be solved by more hospitals but rather through access to primary care physicians, innovations in public health, and lessons from the emerging discipline of behavioral modification.
The best outcomes can be achieved only when the system itself is healthy and built on real partnerships between patients and clinicians. Building a healthcare system centered on clinical professionalism and responsibility is the only way to achieve such partnerships and to ensure that all patients are well served.
Thanks to some pioneering individuals and organizations such as the Mayo Clinic, Virginia Mason, M.D. Anderson, Partners Healthcare, Texas Children’s Hospital, Kaiser and many others, we can now see enough of the future of healthcare to have a sense of what it will be. And it is exciting. Empowering. Better for patients and communities. The new ideas, vision, tools, and methods capable of supporting meaningful change are falling into place.
A frequent companion of challenges is adversity. As hard as it is, one can view adversity as a privilege and an opportunity. During times of great change and adversity, we cannot control circumstances, but we can change how we view them. We need to lean into the adversity. Many involved in the healthcare profession need to see a glimpse of the future, understand their role in it and be sustained by a sense of hope. It is our responsibility — and privilege — to offer this to them.
In a 1913 speech, Sir William Osler said, “To have lived through a revolution, to have seen a new birth of science, a new dispensation of health, reorganized medical schools, remodeled hospitals, a new outlook for humanity, is an opportunity not given to every generation.” To paraphrase Sir William’s message, we have an opportunity to witness a new birth of science, a new dispensation of health, a remodeled health system and a new outlook for humanity. Indeed, this is not an opportunity given to every generation. But it has been given to us. It is our revolution.
Where do you see the medical revolution heading? And what are you doing about it?