Insider-designed processes inevitably become unresponsive.
There's a growing awareness that the current practice of medicine, particularly in hospitals, is inconsistent and poorly regulated. Unfortunately, the most common solution -- to improve efficiency through better central planning -- isn't working. Last week, a New England Journal of Medicine study that showed no impact on hospital-acquired infection rates from a Medicare program to penalize poor performers was the latest blow to administered process solutions in addressing health care's myriad issues of quality, cost, and efficiency.
This month's Health Affairs features a study showing that comparative effectiveness studies usually fail to influence clinical practice. In September, an analysis in The New York Times found that hospitals using electronic records had higher charges per patient. In June, Medpac's report to Congress noted that "recent Medicare demonstrations on care coordination and disease management models have not shown systematic improvements in beneficiary outcomes or reductions in Medicare spending." For all the promise of administered reform, nothing's working.
Dr. Marty Makary's new book Unaccountable offers an insider account of a broad range of hospital failings. From unqualified or impaired doctors to inexpert hospitals to pervasive medical mistakes, Makary's book presents a horror show litany of how care at even the finest institutions can be truly dangerous to patients.