If You Don’t Measure, You Can’t Manage
Management has more in common with medicine than is commonly thought. Both fields are highly specialized sets of knowledge and practices, both aim to cure the patient – whether a person or an organization. Both rely on scientifically verified solutions, and therapies are chosen based on observed symptoms and their interpretation. Finally, the selection and modification of therapies are based on objective data.
It is no surprise that a doctor requires the patient to repeatedly undergo the same tests to decide on further therapeutic action. Therefore, it is all the more surprising to see the huge discrepancy between medical practice and management practice in our hospitals. On one hand, we demand accessible and precise diagnostics, and on the other, we tolerate the lack of useful management information, content with significantly delayed and scarcely useful data. We blame this lack on the shortage of appropriate systems, time, and competencies, and ultimately the inability to measure due to the “complex nature of the subject.” In other words, it is impossible. Perhaps this attitude stems from the belief that without additional financial resources, nothing can be changed anyway. Why measure something that won’t change? Nothing could be further from the truth.
Better Managed Hospitals Provide Better Care
Consulting firm McKinsey, along with the London School of Economics, Harvard Business School, and Stanford University, analyzed 1,200 hospitals, mainly from the USA and Europe. The conclusions from this analysis clearly indicate that better-managed hospitals have better treatment outcomes. But that’s not all. Excellence in management is not linked to public healthcare spending, market and regulatory conditions, or even national culture.
For example, analysis of hospitals in the USA and the UK suggests that a one-point improvement on the management excellence scale results in a 6-7% increase on the clinical outcomes scale (e.g., 6-7% lower 30-day mortality related to myocardial infarction).
It is possible to treat effectively and cost-efficiently, as shown by the experiences of the University of Wisconsin Hospital and Clinics. Reorganizing hospital activities around so-called service lines allowed this institution to neutralize the impact of declining revenue from reimbursed services and achieve improvements in financial indicators and, importantly, patient treatment efficiency.
A service line is a concept implemented by many hospitals in the United States, as well as in the UK within the public health system. It can be organized around a comprehensive treatment path for a specific group of diseases (e.g., cancers), a specific population (e.g., women), or a specific medical procedure (e.g., kidney transplant). Identifying service lines is a strategic decision based on hard epidemiological, operational, and therapeutic data. It allows for rationalizing investments, coordinating within the institution and health system, and identifying and eliminating waste. Each service line executes a comprehensive therapeutic process oriented towards a clearly defined patient outcome. All tasks and resources are coordinated to achieve this outcome.
Management as a Remedy for Underfunding
Even in underfunded hospitals, many reserves can be unlocked by making bold and thoughtful decisions based on objective data. Many examples show that hospitals can offer high-quality medical services and even continue to improve their quality despite a lack of additional funding.
Non-profit healthcare systems in the USA, such as Allina Health (11 hospitals, 42 outpatient facilities, 1,677 beds), Indiana University Health (19 hospitals, 3,326 beds), and Trinity Health (49 hospitals, 432 outpatient facilities, 32 social care facilities in 10 states) are just some examples of how good management based on objective data can lead to better clinical outcomes and savings.
Each of these institutions must deal with rising medical service costs and increasing pressure from insurers to reduce treatment reimbursement costs. Insurers increasingly require guaranteed therapeutic effectiveness. These and similar institutions seek solutions within coordinated healthcare, often defined in terms of service lines. This requires high management competencies and a well-designed system for monitoring financial, operational, and therapeutic outcomes.
Management does not attempt to replace medicine in striving to improve healthcare but creates conditions for the actual implementation of evidence-based and value-based medicine. Patients and payers in Poland and worldwide expect healthcare organizations to finally orient their activities towards comprehensive patient health management instead of providing uncoordinated medical services. The therapeutic outcome remains the leading indicator, but the associated inputs (time, organizational, technical, financial costs) are variables subject to improvement and optimization.
Dual Management by Managers and Clinicians
In hospitals and healthcare institutions where management plays a significant role, a situation of matrix (dual) management of the healthcare delivery process arises, even at the level of specific service lines. The separation of operational and therapeutic responsibilities allows for precise assignment of responsibility and clear definition of decision-making autonomy. This leads to decision-making where the problem arises, and the sense of impact is highly motivating for the involved teams.
Experience in management across various industries shows that the lack of appropriate management information, coordination, and clearly assigned responsibilities for overall activities leads to inefficiency and, consequently, disaster. The healthcare industry is no exception. Management can play a very positive role in improving healthcare, as exemplified by the previously mentioned medical organizations. We cannot expect doctors to take on the task of fixing our hospitals. There are too few of them, and they are too overworked. Additionally, they lack the necessary management competencies, which require many years of work and specialized education to acquire. The solution is dual management, i.e., close cooperation between managers and clinicians, necessarily based on current and adequate empirical data.
The Crisis Has Highlighted Weaknesses
The pandemic caused by SARS-CoV-2 has highlighted the actual state of management in the public healthcare system in Poland. The most glaring example of a management crisis is the inability to collect and report real-time information related to hospital situations, necessary for assessing the situation and effectively coordinating actions within the entire healthcare system. Although the lack of information about their activities is not unique to hospitals in the Polish healthcare system, this weakness particularly undermines public trust in healthcare. It also dramatically limits the central coordination of the fight against the pandemic and the protection of patients’ health and lives. It is in the interest of patients, doctors, and all medical staff to quickly resolve this issue.
The medical community currently has an unprecedented opportunity to demonstrate the quality of its leadership by universally submitting to COVID-19 vaccination. As the Roman historian Titus Livy said – words teach, examples attract. However, the low interest in the vaccine among Polish medical professionals is concerning. How can we expect widespread vaccination among patients, which would allow a quick return to normalcy? Let us hope that the Supreme Medical Council responsible for the medical community will lead to the desired level of vaccination among doctors and thus pave the way to ending the epidemic crisis in Poland.
Photo:
Medical photo created by peoplecreations – pl.freepik.com
