I’m a longtime fan of the comic strip Dilbert. For those unfamiliar, most of the strip’s humor centers on the idiosyncrasies, and sometimes outright idiocies, of life in a corporate office. The tragic irony is that much of it is based on actual tales from real-life offices, and most of the remainder isn’t all that farfetched.
In a more serious portion of one of his Dilbert-based books, the strip’s author offers some of his own remedies for such inefficient, annoying, or downright self-destructive practices of suboptimal workplaces. One seems to scream out for application in the health care field, particularly as we seem to be caught in a positive feedback loop of redundancy which actually reduces overall productivity relative to cost.
The principle is simple enough: Keep a lookout for processes twice or more removed from your core mission, and especially for employment positions which exist solely to attend to these processes.
As an example, consider a pizzeria. The guy making the pizzas is at the heart of the mission. Getting the ingredients and delivering the pies are each one step removed from the actual making of the pizzas, but still very relevant. Someone who conducts focus-groups and travels the country to analyze trends in pizza-making and customer preferences, on the other hand, is at least one more step removed. If that’s all he does, it might be worth reassessing his role in the business. At the very least, a chunk of his time might be allocated to tasks a little more directly related to the bottom line.
Health care seems to have a lot of tasks and positions that are twice or more removed from the central mission. Another field, education, also has this dubious distinction. It’s not entirely coincidental that these two sectors are heavily regulated, if not outright controlled, by multiple levels of government, elected and otherwise — especially since government is probably the best (or worst, depending on your perspective) example of twice-plus-removed tasks, personnel, departments, agencies, etc.
Also not so coincidentally, these fields always seem to be having trouble making ends meet. Once you embrace the approach of spending X amount in the name of efficiency, oversight, and support in order to reduce costs by a fraction of X, it’s pretty easy for budgets to balloon out of control.
There’s not much a field like healthcare can do to reduce its dependency on twice-or-more-removed processes and personnel, once it’s squarely under the thumb of heavy regulation by outside entities. If the government has seen fit to institute such a massive body of rules that it takes an on-staff OSHA team working 24-7-365 to make sure no citations are issued during the next site visit, a hospital pretty much has to bite the bullet and find a way to fit that team into its budget.
If you know you aren’t going to reliably get paid for the work you’ve done (or even avoid investigation for fraud) without having a full-time coder on board, you’re going to have to write that into your cost of doing business as well. At this stage of the game, simplification of our system pretty much has to come from the outsiders who complicated it in the first place.
One would hope that, with all of the “experts” supposedly consulted during the assembly of the health care reform omnibus that was rushed through Capitol Hill, somebody would have seen that serious bending of the cost curve could be accomplished by targeting some of these less mission-essential elements of our overburdened health care system. Perhaps someone did — unfortunately, such hypothetical individuals didn’t have much of an effect. The reams of pages within the law now being reassessed by the Supreme Court seem to be heading in the completely opposite direction.
