Last week, Bill Moyers interviewed Jim Yong Kim, a distinguished medical professor and leader of nonprofit organizations and the new president of Dartmouth College. A lot of Kim’s work is dedicated to improving health in the developing world, so you might think he is some sort of soft-hearted lefty. But one of his main points about our health care problems was that our health care delivery system is not sufficiently tough-minded and calculating, and that health care providers can learn a lot from the business world. For example:
“JIM YONG KIM: So a patient comes into the hospital. There’s a judgment made the minute that patient walks into the emergency room about how sick that person is. And then there are relays of information from the triage nurse to the physician, from the physician to the other physician, who comes on the shift.
“From them to the ward team, that takes over that patient. There’s so many just transfers of information. You know, we haven’t looked at that transfer of information the way that, for example, Southwest Airlines has. Apparently they do it better than any other company in the world.
“BILL MOYERS: Computers?
“DR. JIM YONG KIM: No, they have taken seriously the human science of how you transfer simple information from one person to the next. And in medical school, and in the hospitals that I’ve worked in, we’ve done it ad hoc. Sometimes we do it well. Sometimes we don’t do it well. But what we know is that transfer of information is critical. Now to me, again, that’s the rocket science. That’s the human rocket science of how you make health care systems work well.”
In other words, to take just this example, we know that the way information is transmitted can have a major impact on the quality of health care, yet most people in the field neither study it or pay attention to it. Why is this? Kim points to a few reasons.
First, there is the myth of technology: “I think for many, many years, we’ve been working under the fantasy that if we come up with new drugs and new treatments, we’re done.”
Second, there is the peculiar nature of the health care delivery market: “What we’ve learned about organizations is that it is very difficult to get a complex organization, a group of people, to work consistently toward a goal. In the business world, if you don’t do it well, the market gets rid of you. You go out of business. But many hospitals executing very poorly persist for a very, very long time.”
And third, there is a cultural aspect: “I’ve noticed over the years that when it comes to our most cherished social goals, not only do we tolerate poor execution, sometimes we celebrate poor execution. Sometimes it’s part of the culture. You know, these folks are trying to solve this terrible problem. They can’t keep their books straight. They really don’t know what they’re getting. They don’t measure anything. But they’re on the right side, so that’s okay.”
Kim’s solution is something that the Dartmouth Institute has been doing: study outcomes, and study them scientifically, so you can identify what inputs lead to what outputs. I don’t think this is a sufficient solution, because even if you know exactly how to deliver high-quality, low-cost health care, if physicians are still being paid more to conduct unnecessary tests, they will conduct those tests. But if you don’t know how to deliver high-quality, low-cost health care, then you are just wandering around in the dark.
By James Kwak