Remember the games of the analogue times, precisely the moment when the player put the piece in the wrong place and there came a warning sound and the red light lit up the nose? Now it looks like a naff old thing, but I liked that Robert Kaplan and Derek Haas have chosen the image of one of these games, precisely one that is for operating a patient and that they have chosen it to illustrate their article published in the Harvard Business Review blog, "How not to cut health care costs".
When faced with budget cuts, they say, health managers around the world apply the same recipe: reducing staff costs (both in numbers and in wages), optimize the use of space to save general services, stop investments and rationalize spending. The authors do not maintain that this package of measures is poorly done, but they question whether behind these policies there isn’t a strategic way of thinking that combines resources to achieve the best results in the most efficient manner possible and the efforts of the basic savings pack can become counterproductive for the health of people and also for the economy of organizations.
Therefore, we should appreciate that the article analyzes five errors of the basic savings pack, while proposing five alternatives focused on efficiency and effectiveness.
1) Savings by reducing administrative and support staff
This measure will force doctors and nurses into performing tasks inappropriate to their skills and this reduces the performance of care in addition to causing discomfort in these groups. For this reason, Kaplan and Haas, make a proposal almost in the opposite direction: if each professional level assumes functions at the upper limit of their capabilities, without going further than that, this implies that the processes are performed more efficiently and this makes everyone more comfortable. Some examples are the structured programs of communication with patients via email, the demand nurse management and the advanced practice nurses for chronic patients and the meetings between family physicians and specialists.
2) Savings on equipment and spaces
Before stopping investing, managers should bear in mind the cost-effectiveness studies, inherent in the divestment, given that the biggest waste in a health organization can be found in idle doctors and nurses. A couple of illustrations: a) many studies warn that for programmed interventions, type cataracts or replacements of joints, it is very advantageous to provide two operating rooms for each team of surgeons: their performance can be doubled, b) purchasing a portable ultrasound system and training staff for using it can produce good results and can generate savings in unnecessary radiological requests.
3) Streamlining purchases
One of the consequences of the crisis is that, with greater or lesser success, virtually all health organizations have addressed the spending management, and in many cases, collegial groups have formed in order to purchase products at a better price. But in most cases, the pending task is involving doctors and nurses to work together with managers, thus the buyer would better understand the clinical nature of each order. The variability of consumption shows that in this area there is still a long way to go.
4) Increasing doctors’ productivity
If the data that controls doctors’ productivity relies only on time per visit, we are at a dead end. Appropriate questions, however, should be: do patients really need to visit a doctor? And once this has been adequately answered, the next question is whether the doctor has spent enough time with each patient. According to the authors, it has been demonstrated that the brevity of the meeting between doctor and patient is the genesis of excessive unnecessary referrals and prescriptions.
5) Failure in standardization and benchmarking
Dr. John Noseworthy, Chief Executive at Mayo Clinic affirms that that most doctors practice medicine based on eminence, rather than evidence. Unfortunately, he says, health professionals are often unaware of the costs associated with their performances. For this reason, the study's authors believe that a lot more effort ought to be made for providing doctors and nurses with results information and costs, and that despite the crisis, they say, this is a field in which organizations have advanced very little, if at all.
Kaplan and Haas believe that with the basic saving measures packs, many mistakes are being made (the little red nose lights up way too often). Now, they say, we ought to focus on the efficiency and effectiveness to reduce waste, i.e.: a) go much further with delegation of authority, b) invest in cost-effective projects, c) involve doctors and nurses in purchases, d) allocate doctor and nurse time to patients who need it, and e) compare, where possible, outcomes and costs between professionals and equipment.