By guest contributor and TEDMED 2015 speaker Thomas H. Lee, MD
For years now, experts have said health care should move “from volume to value,” and the good news is that it’s finally happening. Even within the past few months, the pace of change has accelerated. More and more payments to providers are tied to quality and efficiency, and increasing amounts of data on their performance are being published online.
In my TEDMED talk, I spoke about how the reduction of suffering was becoming the focus for health care. Today, many health care providers are starting to compete on how well they meet patients’ needs.
As this competition increases, health care providers can look to four key thought leaders whose work influences my own every day: Michael Porter, Leemore Dafny, Ronald Burt, and Nicholas Christakis. Individually and collectively, their contributions provide clarity on what we need to do in health care, why we need to do it, and how to get it done.
Over the last few decades, Michael Porter of Harvard Business School has defined the meaning of strategy for business in general. His work on health care clarifies why an overarching strategic goal is important for every organization, and why that goal should be to create value for patients. He and his colleagues have described how multidisciplinary teams should look, and what kind of information and incentives those teams need to drive improvement.
If Porter’s work describes the “recipe” for what we need to serve in health care, Leemore Dafny helps us understand the heat that is necessary to start things cooking. She is the Harvard economist who has studied payer and provider consolidation and shown how it leads to weaker competition and higher prices. I have long been leery of thinking about health care as a marketplace, concerned about unintended consequences if patients have to act like consumers and make tradeoffs in quality and price. But Dafny and her colleagues are persuasive when they argue that competition in a value-driven market has greater potential to drive improvements in quality and efficiency than the alternatives – and that providers like me should embrace competition and learn to trust market forces.
Porter and Dafny’s work tell us what we have to do, and why we have to do it. But how do we get that work done? Part of the answer is to strive for the creation of social capital.
For the last several years, I have given a book to virtually every new close colleague: Brokerage and Closure: An Introduction to Social Capital by University of Chicago sociologist Ronald Burt. We all know about financial capital (the funds that enable organizations to do things they otherwise could not do), and about human capital (hiring good people). Social capital is about how those people work together. If they are reliable in their coordination, the organization can make leaps in quality and efficiency. Burt provides a clear and useful structure for learning (increasing variation in what is done by brokering ideas) and then converging on best practices (closure).
Then there is the challenge of how do we make collaboration and compassion the norm in health care. Financial incentives cannot get the job done. That is why I think so often of Nicholas Christakis, the Yale social network scientist who has shown how epidemics of values and emotions can spread from person to person. While the work of Porter, Dafny, and Burt define the big picture, Christakis characterizes the nature of the work that needs to be done on the ground.
There are, of course, many more colleagues whose work I respect and learn from, but these four constitute a “package” that I think can accelerate the transition to a new and better health care system.
In his TEDMED talk, quality care pioneer and Chief Medical Officer of Press Ganey, Tom Lee reveals his passionate quest to define empathy as a business asset and patient suffering as an outcome.