June 24, 2011
The 1968 John Wayne movie, Hellfighters, has just stuck with me.  IMDB reduces the plot to this:  " The story of macho oil well firefighters and
The 1968 John Wayne movie, Hellfighters, has just stuck with me. IMDB reduces the plot to this: " The story of macho oil well firefighters and their wives. " When the Hellfighters are fighting the first oil well fire, they explode nitroglycerine over the oil rig to extinguish the fire. While burning, in addition to the intense heat, these fires often fill the air with acid and poisonous gas. The movie culminates with a fire where several oil wellheads in relatively close proximity are all burning simultaneously, and extinguishing them requires simultaneously and precisely detonating the nitroglycerine over each of the heads. Being Hollywood and all, there are also guerrilla terrorists taking riffle shots at our heroes while they're trying to achieve an otherwise nearly impossible, heroic task. And of course, the key characters are on the brink of failing marriages, so they're bringing their wives with them into these dangerous places. Phenomenal action and drama ... just like healthcare improvement initiatives in the U.S.? Excuse me? Where did that come from? Here's my point. Improving the healthcare delivery system will require simultaneous solutions; otherwise, a tweak here or there will simply inflame the problem somewhere else, probably explosively. Here are two clean but simplistic recent examples: Fixing Health Care Starts With the Doctors By Steven Pearlstein, Wednesday, June 10, 2009 It's the doctors, stupid. If we really want to fix America's overpriced and under-performing health-care system, what really matters is changing the ways doctors practice medicine, individually and collectively. ... ... and the first reply comment (when I read it; it's no longer the first reply) ... camiolo wrote: "Like many health reformers, Gawande says the essential problem with the American health-care system is that so much of what we spend -- as much as a third of the $2.3 trillion spent in 2007 -- goes toward care that is either unnecessary or inappropriate. Fixing that is the first step to fixing everything else." Wrong. The first problem to fix is paperwork. There's so many different forms that need filling out depending on which insurance plan the customer is on. And once everyone is on the same paperwork path, we can start to accurately track and measure the consumption of Health Care. Then we can decide what care is unnecessary or inappropriate. I and other bloggers here, most recently Pam Arlotto in her Whack-A-Mole post, have pointed out that the healthcare performance challenge is a system issue. A focus on the underlying processes is essential. In the spirit of Hellfighters, I think that the most parsimonious characterization of the problem we're trying to address, in part with HCIT, has three elements: Cost, Quality and Access. In political speak, increasing the number of covered lives, while simultaneously and dramatically reducing the national costs for healthcare. Each of them requires behavior change and payment reform that are simply flip sides of the same economic coin. Simplistic deductions like "the doctors are the problem" or "paper is the problem" or "payment/payors" or "consumerism out of control" or "attorneys" or "obesity" or "greed" are the problem reduce a complex situation to an absurd caricature. Elevating the importance of one fire over another, or discounting the significance of a non-pet component of the issue will not lead to improvement. Quite the opposite. I've outlined my thoughts on where to start in Vowels of Care, which is a systematic thought. If you're interested in reading an intelligent elaboration of the components of healthcare reform and the sloppy thinking, you'll find that in the comments starting with camiolo's above ( link). (The roofing analogy really struck me as right on. So did radiotesla's wife.) Healthcare reform is a Hellfighters scenario.

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