Healthcare has Too Much Strategy, Too Little Care

Healthcare has Too Much Strategy, Too Little Care

Healthcare is trending towards two distinct classes. One is the strategist, the grand vizier overseeing the healthcare system writ large. The other is the clinician, the provider whose role has been relegated to a series of checkboxes, reminders, and care gap analyses.

The first thinks strategically. The second executes the strategy. It sounds nice at first blush. But like all first impressions, it falls prey to delusions of grandeur that fall apart through the test of time.

As a result, healthcare has accumulated mounting delusions about the strategy it professes and the operations it can realistically implement. We are wowed by grandiose visions, yet we execute through ritualized, regimented decisions and standardized guidelines, as though all of medicine can be captured through a series of care gap checkboxes.

What is missing in the gaps are the subtleties that define the patient, physician encounter. They make the aspirational strategies appear downright delusional.

Of course we know healthcare must be efficient. We know costs are exorbitant and patient engagement is few and far in between. But we fail to recognize the core realities required to improve on this. Most innovations that claim to address health inefficiencies are simply empty calls for increased utilization.

There is nothing glamorous or innovative about it. As a matter of fact, it is the direct opposite of what we think of as healthcare innovation. Yet it is what is most needed. It means scrubbing patient notes for labs that should have been ordered or imaging studies that should have been pursued. It means painstakingly reviewing charts for things that were discussed, that should have been discussed, and parsing through what happened and what should have happened.

Healthcare is rough and meticulous, defined not through any innovation, but through the small-scale decisions and initiatives that lead to actual patient outcomes. It is more blocking and tackling than grandiose strategy.

These so-called strategists who wish to improve on healthcare through some novel care model or perceived insight would be far better suited working among the tried and true, engaging in a good old fashion chart review. We need less strategic planning or vision statements, and more dirty work.

Sit in front of a pile of patient records and review – detail by detail – what was done, what was missed, and what it will take to address what was missed. There is no glory in detail, no award to be found in the records. But this is how to improve healthcare, and what we miss when we prioritize innovation over common sense, and strategy over operations.

An army derives its strength on the merits of its decisions, made by individuals from top to bottom. Every war was won or lost based on the decisions of the rank and file soldiers implementing the general’s grand strategy. The ability to inspire is as important as the strategy concocted.

Just like a health care leader’s ability to inspire its workers to execute high quality care is as important as the vision itself – perhaps even more so, given the over-abundance of healthcare strategy and purported innovations. We all know what needs to be done. It is a matter of inspiring people to do it.

We need more leaders willing to work in the trenches, to do the dirty work, the work that carries no glamour but instead creates the credibility needed to inspire the rank and file healthcare workers executing the vision.

Let us start with a good old fashion chart review. Have the hospital’s leaders and strategists sit with the clinicians and go through the records and determine where improvements need to be made. As painful as it may appear, the suffering will be worth the credibility gained. In fact, it will be downright inspiring.

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