Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Health care efficiency can mean different things

Rahul K. Parikh, MD
Policy
July 31, 2014
Share
Tweet
Share

Whether you’ve praised or vilified Obamacare, see it as an amazing achievement or an existential threat, it is the law of the land.  The price transparency created by online exchanges, a vital part of the law, stands to make cost the biggest driver of choice. This, along with cuts in government health spending, will disrupt the economics of health care in dramatic new ways.

Our first response to this brave new world is to declare that American health care needs to be more efficient. While this is not a new refrain, it is one being heard more loudly and urgently, from the office of the solo practitioner to the boardrooms of the most reputable hospitals and health care systems, than ever before. The Center for Medicare Services, the Institute of Medicine, and even the White House have endorsed the need for greater efficiency.  Employers and other payers want to factor efficiency into their decision about whether to use the services of a particular doctor, hospital or health care system.

But just what is efficiency in health care?  In many other industries, the answer is clear: produce or move more goods with the same or fewer resources (money, people, machines).   What turns out be both striking and surprising in health care, however, is that the term is a bit of a Rorschach test — prone to interpretation depending on who you ask and the lens through they view things.  Without a common understanding, any chance of making American health care better stands to stall.

I learned about this lack of clarity as I spent some time asking a variety of stakeholders  — both inside and outside of my health system — about what efficiency means.  Rarely were there two identical responses.  Physicians, those who see patients day to day in the trenches of their exam rooms, identified efficiency to be “less paperwork,” “more time,” or, for those who use electronic medical records, “fewer clicks of the mouse.” Some nurses I asked came back with comments about “patient ratios.”  Other health professionals had still other interpretations.  “Using technology to educate and help patients ‘own’ their health care decisions,”was one from a patient educator.

When I asked the question of those a little higher up the health care business food chain, the answers sharpened somewhat but were just as diverse. “Eliminate waste,”“do the right thing the first time,” “save money ““high quality service at affordable rates” were among them.  Finally, I took the time to ask some patients: “give me what I want or need,” “convenience,” “one stop shopping,” and “don’t keep me waiting” came back to me.

Why is it so hard to find agreement on the meaning of efficiency?  One reason is that we cannot agree what to measure. In a review of over 250 articles, a team of researchers found very little overlap among measures being used to measure efficiency.  Among any they did find, few to none have been subjected to rigorous evaluations to measure their reliability, validity, and sensitivity.  Finally, the researchers found very little overlap between any of these measures and measures of actual quality of care. Just as my informal poll of doctors, health care workers and patients found,  “the term efficiency is used by different stakeholders to connote various constructs.”

Another reason for our lack of agreement may have to do with the origins of the idea itself:  The concept of efficiency comes from a place that seems far removed from the internist’s exam room and the surgeon’s operating suite: the factory floor.  Efficiency was originally championed by the 19th Century management pioneer Frederick Winslow Taylor.  Taylor was steel factory machinist who saw who recognized that workers were not nearly as productive as they could be. He set about analyzing and scrutinizing their work habits so his factory could produce more widgets with a defined set of people and machines, the very definition of efficiency that we still use today.   He is widely credited as having launched management science and his career was loosely portrayed in the movie “The Efficiency Expert. ”

Attempts to translate this industrial view of efficiency to the world of medicine face resistance. There are no blue collar physicians.  We believe, by virtue of our ideals, education and rigor of our training, that our work cannot be standardized. A physician’s office, from reception to waiting to exam room is not an assembly line. Patients can’t and should never be seen as widgets to be moved along the floor.  On the contrary, we are professionals who use specialized skills (scientific and humanistic) to care for our patients. And even if each of those patients has the exact same problem, differences in their expectations, assumptions, values and a myriad of other factors make each non-interchangeable. Hence, the practice of medicine, a point of view that immediately casts doubt on the idea of efficiency among those on the front lines of medical care.

One solution to our dilemma is to acknowledge that (perhaps) efficiency is too insular a view.  Perhaps some rhetorical jiu jitsu, one which puts the patient out front, is a better approach.   Harvard Professor and health care thinker Michael Porter and former health care executive Thomas Lee hinted this recently: “Efforts to reform health care have been hobbled by lack of clarity about the goal … Narrow goals such as improving access to care, containing costs, and boosting profits have been a distraction,” they wrote in a recent article for Harvard Business Review.  Some of these items he mentions could easily be lay definitions of efficiency, like those folks gave me in my informal poll.

Porter and Lee offer a solution: To look outward by establishing a value agenda, one in which American health care moves away from a system organized around volume of visits, procedures and a system based what physicians do to one in which care is better coordinated around patients and the outcomes that matter to them, such as their time to recovery after illness, how sustained their recovery remains and their functional status, for example.  They outline 6 components to achieve this, which include organizing into integrated practice units, coordinating care across facilities, and moving to bundled payments for cycles of care.  While parts of these have certainly been established in various health care settings, any group that establishes the full complement of them will have a strategic advantage in the post-ACA world.

With their value agenda, Porter and Lee don’t jettison efficiency as much as they reframe it.  “At its core maximizing value for patients: that is, achieving the best outcomes at the lowest cost.”  This they argues, increases “the efficiency of providing excellent care.”  Thus, Porter and Lee turn the tables from an internally focused view where everybody agrees to disagree about — even abhor — the meaning of efficiency to one which those who truly have a patient-centered mission can set as a destination.  I’d be hard pressed to find a physician, non-physician colleague or patient who wouldn’t want to get there.

Rahul K. Parikh is a pediatrician and a writer.  He can be reached at his self-titled site, Dr. Rahul K. Parikh.

Prev

It's time to bring back morbidity and mortality conferences

July 30, 2014 Kevin 3
…
Next

It’s time we stood up for the orphan of organs: the brain

July 31, 2014 Kevin 0
…

ADVERTISEMENT

Tagged as: Public Health & Policy

Post navigation

< Previous Post
It's time to bring back morbidity and mortality conferences
Next Post >
It’s time we stood up for the orphan of organs: the brain

ADVERTISEMENT

More by Rahul K. Parikh, MD

  • a desk with keyboard and ipad with the kevinmd logo

    The Apple Genius Bar could learn some bedside manner

    Rahul K. Parikh, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Medicine needs to get back to hands-on basics, rather than focusing on technology

    Rahul K. Parikh, MD
  • a desk with keyboard and ipad with the kevinmd logo

    What health reform can learn from Regina Holliday

    Rahul K. Parikh, MD

More in Policy

  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • The hidden health risks in the One Big Beautiful Bill Act

    Trevor Lyford, MPH
  • The CDC’s restructuring: Where is the voice of health care in the room?

    Tarek Khrisat, MD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Health care efficiency can mean different things
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...