On "Medical Homes" & Healthcare as a Business

The most constructive critiques are usually a double-edged sword, and this one's no different.

Today the latest issue of the Journal of Healthcare Management, published by the Foundation of the American College of Healthcare Executives ("for leaders who care (R)," and of which I am a member), arrived via my friendly Dutch postal carrier.

Here's the sweet spot...

It is the FIRST issue of JHM that I've been unable to put down (in just over a year of devoted, cover-to-cover reading).

In fact, it is the first issue I found directly relevant to current healthcare management issues. Usually (sorry ACHE) I reserved JHM for bathroom reading.

Editor Kyle Grazier sets the right tone with her editorial. This issue, finally, is "A call to arms."

Articles included succeed in raising "awareness, attention, and action." Hope this quality coverage continues.

JHM has also chosen to run 2 new columns, the most interesting being Sandy Lutz's ongoing discussion of "current trends and future implications of consumer-driven healthcare."

Each issue of JHM starts with a 'famous person' interview, highlighting someone in the field of healthcare management (usually FACHE certified, naturally).

This issue interviews Lucian Leape MD, an adjunct professor of health policy at Harvard.

Dr. Leape has heaps of experience in the field, more letters after his name than I can ever hope to obtain, and makes a hobby out of testifying for Congress about healthcare safety and quality issues.

I agree with many of his views (including the fact that we'll have a national effort in the US to enforce patient safety goals in the near future).

However, one sentence on page 75 made me check while filling out my mutual admiration society card. And here's the sword...

Dr. Leape says: "Part of the reason for this is that the American healthcare system puts so much emphasis on the business of medicine."

It's here, Dr. Leape, that I beg to differ.

In fact, it drives me nuts when I hear this line.

This is NOT the problem. We don't place too much emphasis on the 'business of medicine.'

The problem is that we're trying to morph a cottage, craft-based industry composed of loosely organized individual practitioners into a working, centered, corporate-efficient business model nearly overnight.

But we're failing at it.

If we weren't, we'd recognize the value of getting and retaining human capital (staff).

If we weren't, we'd recognize the value of getting and retaining customers (patients).

Integrating a 'business of medicine' approach and creating a care environment that puts safety at the forefront are not mutually exclusive strategies.

Creating a safe, productive, empowering, efficient, empathic environment of care (for both populations) is THE primary tenet necessary to achieve both goals.

A well-run business would recognize this and realize ROI in both profits and people, dollars and dreams realized, loyalty and less lawsuits.

It's not that we have too much 'business' in healthcare Dr. Leape - it's that we have too little.

The latest 'care' based healthcare initiative slaps a new customer-friendly tag on an old search.

Pundits and analysts (many of whom I respect and whose views I admire) are looking to solidify the amorphous concept of consumer-centric care around a universal 'medical home.'

To all those looking, forget it. We're grasping at straws.

This is the healthcare industry equivalent of Arthurian legend.

No single heroic stratagem will pull the sword from the stone and save the kingdom.

Stop searching for a larger-than-life solution - a much more self-effacing hero already exists.

The 'medical home' we're all looking for is embodied (literally) in each patient we see, each consumer we 'touch' with a Health 2.0 communication.

Stop thinking of 'safety' initiatives as universal measures that can be implemented mirror-image in each clinical setting.

New checklists and protocols to prevent medical errors most appropriately begin centered around the experiences, prognoses, and wellness goals of each patient, taking into account clinical pathways and docs orders, of course.

That's not just safe, empathic medicine Dr. Leape, it's good, efficient business practice.