What is it about?
This paper concerns a major issue confronting our health care system; the frequent tension between those managing the delivery of services and those delivering the care. This is a particular problem in primary care and behavioral health, especially for those delivering services to low income and uninsured populations. The paper presents the premise that this tension is more derived from differing perspectives than from a differing commitment to purpose and the need for change and improvement. The “Triple Aim”, the need to improve health, improve the quality of the care experience and to reduce costs, is viewed as the essential guide to improving health care in the United States, an important shared purpose for management and service providers. But, dissatisfaction and burnout of clinical staff follows when its pursuit by management overrules the clinical teams sense of what’s best for patient care. We propose that health care delivery systems will be more successful when those managing the organization understand that resistance to change from clinical staff comes from a valid and valuable perspective, and organizes to support the values and concerns of those delivering care, allowing them to be key authors of needed changes as the Triple Aim is pursued.
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Why is it important?
While the Affordable Car Act enabled many more Americans to gain medical care insurance, the Act needs improvement and the United States continues to have a very costly health care system, with poor health outcomes when compared to most wealthy nations. Many remain uninsured and even if insured may still lack access to sound disease preventive and health promotive services. The solution requires an ongoing, balanced focus on improved community health, a better care experience and lower costs. The existing, common discord between those directing service delivery and those providing it will result in limited improvements if not failure. Resolving this discord requires a shared purpose and the understanding that the perspectives of those delivering services need to be respected and addressed, not simply overruled.
Perspectives
The United States has a very expensive and inefficient health care system. It especially fails in supporting the health of low income populations, particularly Blacks and Latinos. This is the direct result of the financial incentives that shape our system. The dominant financial incentives reward the aggressive study and management of disease, while underfunding those components that promote health: public health, primary care and behavioral health. While often providing superb care for the sick, this results in high costs and a lower life expectancy than in most other industrialized nations. The Affordable Care Act provided the strongest federal effort to correct this problem since Medicare and Medicaid were legislated in the 1960’s, but it will not succeed without major improvements in care organization and delivery. While America remains ambivalent to this, I hope those in health care will sustain the focus on improving health and quality at lower costs. This requires a better alignment between management and service providers than exists in many if not most health care delivery systems today.
William Bateman
New York University School of Medine
Read the Original
This page is a summary of: Health Care Providers and Managers: Seeking Concordance in the Discord, American Journal of Medical Quality, July 2017, SAGE Publications,
DOI: 10.1177/1062860617718934.
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