Preface
Not so long ago, health care was organized around what physicians did; it is now undergoing a fundamental re-organization around meeting the needs of patients. This change is not based upon the sudden evolution of health care providers to some more altruistic state, or the seizure of power by patient advocates. This change reflects progress in our understanding of the real challenges we face in health care delivery, and enhancement of our ability to meet them.
For practical purposes, the earlier physician-centric era can be defined as the period before the 1999 publication of To Err is Human by the Institute of Medicine (IOM). Before that report, the widespread assumption in health care was that quality was basically just fine, and not really measurable in any case. A further assumption was that most actions by health care providers were beneficial to patients – and that the more providers did, the more good they would be doing. Accordingly, health care providers, their leadership, and their governing boards focused on doing as much as possible, and on maximizing the revenues they received for their activities – so that they could invest in the resources they needed to do even more.
The IOM report revealed, however, that all was not well in health care, that errors occurred with unsettling regularity, and that many had devastating consequences. Quality could in fact be measured, and the data that emerged revealed variability and unreliability. These painful insights meant that health care could no longer be organized around maximizing clinician activities that were reimbursed under fee-for-service payments. Instead, the paradigm that has steadily won acceptance is that health care should be organized around reliably meeting the needs of patients, and doing so as efficiently as possible.
This change in focus does not devalue the hard work of clinicians; it simply means that this work needs to be conducted with a more appropriate goal than maximizing fee-for-service revenue. That goal is meeting patients’ needs – it is producing health itself, not just producing health care.
The pursuit of that goal has become increasingly realistic – indeed, it is defining the life work of many of the “best and brightest” of young health care providers today, as well as their predecessors. How to measure what matters to patients is more deeply understood, as is the way in which clinicians need to work with each other and with patients themselves in order to enhance outcomes. Indeed, I believe that a vibrant health care marketplace is emerging in which providers truly compete around creating value for patients – and that providers who may have been skeptical or oblivious to market needs in the past are realizing that such competition will reward providers who are most innovative and effective. Their patients will win as well, with better and more affordable care.
In the exciting period that lies just ahead, more will be needed than simply connecting patients to clinicians, and clinicians to each other. The health care systems that will be most effective in meeting patients’ needs will be those that can actually design their “human-ware” around that purpose. This book provides deep insights into how information technology can and will support that redesign. In all likelihood, the health care providers that are most effective and efficient in making these changes will be rewarded with market share, business success, and pride in the quality of care they are delivering.
Chief Medical Officer, Press Ganey Associates,
South Bend, IN
Professor of Medicine, Harvard Medical School
and Professor of Health Policy and Management,
Harvard School of Public Health, Boston, MA