Did he really say that?

A small quote in the San Francisco Chronicle caught my eye this morning:“Hospitals are not really safe places to be … You only want to be there if you have to be there.”I did a double take on that one.After all, while no one likes going to hospital, isn’t that where you find the marvelous concentration of doctors, and nurses, and all that expensive medical equipment that’s just what we need (when we need it), and emergency rooms, and operating rooms?  And don’t people go there precisely when they’re sick or injured?  So isn’t a hospital the safest place to be?  The right place to get care?Apparently, and sadly, not.So how has the system gone so wrong as to produce exactly the opposite of its purported aim?(The speaker was Paul Markovich, Chief Operating Officer of Blue Shield of California, a 3.3 million member health plan.  The article was (the very poorly headlined) “S.F. experiment hopes to improve medical treatment, lower costs” by Emily Bazar, on page 1.)Suppose that Markovich is correct, and given his job is it reasonable to assume that he may be, then what does this tell us about the American health care system?  A lot, it seems, and most of it is bad news.How could the hospital that millions of people depend on for care be unsafe?It could happen because the ‘system’ of care, and the way that hospitals are organized and run, has become totally out of sync with the stated and intended purpose of ‘health care.’  Perhaps you’re one of the many who have experienced this, the dehumanization of hospitals, the mountains of paperwork, the agonizing wait for approval for ‘procedures,’ the faceless bureaucracy that issues edits, unseen.  Hospitals are sometimes like no-man’s land, where the medical staff and the administrative staff are at war over control of the process and the outcomes.This happens because institutions have put functions like ‘administration,’ ‘procedures,’ ‘policies,’ and the dreaded ‘reimbursement’ at the center of their work, and the ‘care’ part of health care is often, it seems, secondary, because the flow of money is driven by procedures and reimbursement rather than by the logic of medicine.This is not to say that people who work in hospitals are uncaring.  It’s the opposite, of course.  But the ‘system of care,’ as a system, is in dire need of rethinking, as its purpose has become lost.Russell Ackoff, a great mentor to countless students and executives over his decades as a professor and consultant, made this point many times during his illustrious career, as he labored relentlessly to help us understand how the behavior of systems could divert itself onto tangents that ended up achieving exactly the opposite of the stated and intended goals.Many of Russ’ teachings are expressed in the tongue-in-cheek look at management that he co-authored with Herb Addison, Management f-Laws.Here’s a pertinent excerpt:“An organization is a system and the performance of a system depends more on how its part interact than on how they act when taken separately.  Suppose the automobile with the best motor is identified, then the one with the best transmission, and so on for each part that an automobile requires.  Suppose further that these parts are removed from the care of which they are a part.  Finally, these best parts are assembled into an automobile.  We would not get the best possible car; in fact we would not even get a car because the parts would not fit together, let alone work well together.  Similarly, if each part of a corporation is improved, it does not follow that the organization as a whole will be improved.  By improving parts separately, the whole care be put out of business.  Evaluation of the performance of parts of an organization should be based first on their effect on the whole, secondly on their individual performance.”  (page 5)This is a very concise statement of the problem facing the American health care system.  (And the Chronicle article tried to make this point, sort of.)American health care has been optimized not for the performance of the whole, namely the health of the American people, but for various parts and pieces that do not fit well together (such as the earned income potential for physicians, the profits of hospitals and insurance companies, and the treatment of acute disease and injury rather than chronic conditions.  As a system, hospitals are poorly coordinated, as the same article points out a bit later on, with the unbearable statistic that the Medicare system made $48 billion in ‘improper’ payments in 2010, which constituted 40% of the federal government’s wasteful spending (according to the Government Accountability Office).This is a ‘system’ in desperate need of a strong dose of ‘systems thinking.’  Rethinking this massive system will not be an easy job to accomplish, but it is certainly the necessary one.And until it is done, sadly, then hospitals will continue to be dangerous places, when they should be exactly the opposite.