Management of Change: A Retrospective Study of Change within the World of Healthcare

Few people would argue that health care systems around the world are in heavy need of overhauling. This is especially true in nations such as the United States, where there are desperate measures being taken to control the rising costs of U.S. health care. The problem here is that every solution has major drawbacks, and it would seem that there really is no optimal solution to the problem of balancing health care costs, quality, and availability. For this reason, it is necessary to examine some of the ideas presented by experts to determine at least the beginnings of a proper course of action.

Porter and Lee are two researchers who have two different strategies to help get health care out of the current rut it is in. The first strategy that they proposed is what they call "value-based health care," the underlying concept of which posits that a pure and total commitment to the patient, rather than other goals such as profit, will help health care programs to survive in the long run, and ultimately create better value for the customer (Porter and Lee, 2004). The second strategy involves health care facilities being much more specialized "... we must replace today’s fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health-delivery organizations and in the right locations to deliver high-value care" (Porter and Lee, 2004, p. 65). This strategy posits that lightening the load on every health care establishment to instead focus on one area that establishment does well should create a much less splintered health care system. However, only one of these two concepts is truly viable: the former one, about total commitment to the patient. Segregating health care into many different parts would be a recipe for disaster.

The concept of consolidation vs. fragmentation was examined by Bazzoli in his paper Two Decades of Organizational Change in Health Care: What Have we Learned? In it, Bazzoli mentions that, around the 1980's and 1990s, there was a large amount of consolidation of physicians and hospitals, which was met with mixed results but that was, in general, effective (Brazzoli, 2004). While Brazzoli would be the first to argue that there is a definite change required in the health care industry, the solution lies in consolidation, not further fragmentation, as Porter and Lee recommended. The reason for this comes from the virulent nature of the health care industry, which is currently precariously balanced on a tipping point the size of a pinhead, and altering health care systems drastically would likely result in the whole system crashing down. Obviously, that should be avoided, and so Porter and Lee's first strategy should be utilized instead of their fragmentation one: making health care more about the customer.

This strategy has promise because it invests in the one factor that will be consistent throughout the entirety of the health care issues: patients. The consolidation strategy that Brazzoli mentioned came about largely as a defensive measure, as health care had been deteriorating for a long time before the consolidation happened. In fact, studies show that in the 1990s around the time the major consolidation was beginning, Americans were receiving not just sub-par health care, but health care that actually exacerbated negative symptoms, leading to further degradation of the health care system, despite efforts to consolidate (Aday, 2002). Health care procedures have only gotten worse since then.

This helps to establish a guideline for the implementation of the patient-focused approach in healthcare management. For starters, the changes made to the health care system should be minor at first, and only ramp up until or unless it is obvious that the change will have detrimental effects on the health care system as a whole. That said, the best way to implement a patient-focused strategy is to give these patients options. For example, if a patient requires urgent care yet does not have a large amount of money, nor insurance, hospitals should have a network in place that will allow them to be paired with a lower quality hospital that will offer the same procedures at a much lower price. This creates the rather obvious barrier that many low-income patients will receive sub-par care simply because they lack funds, but the alternative is that they are treated immediately by a higher-quality health care establishment, then shackled by health care bills that could take them years to fully pay off. At least this way the patient (or friends and family of the patient) can opt to take the risk of lessened quality in exchange for a price. This naturally brings up the unintended consequence of uncertainty regarding which health care establishments are and are not "quality." There are many different theories about how the "quality" of a health care establishment would be determined. The answer, researchers posit, is simple: use third party organizations to individually examine and rate each health care establishment, with the lowest in quality being forced to offer certain rates, and so on (Cleary and Edgman-Levitan, 1997). This would also give those struggling health care establishments that are battling with low patient numbers more of a chance, as their new low prices would surely bring in more patients and help to balance costs.

Any sort of change in the organization of health care brings about certain risks, but the proposed solution of focusing on the patient can only be beneficial in the long run. Focusing on one's clientele in any business is almost always a sound long-term strategy, and health care, being a business, is no different. The problems with the organization are numerous but splintering the health care establishment further is not the way to a more effective system, as this would only complicate the system further. Instead, leaving the current, consolidated system the way it is, while also shifting gears to focus on the patient, will ensure long-term success for health care. Having an effective health care system is a must for most countries, especially those with a quickly-aging population such as the United States, but with this plan, hopefully, these citizens will all be able to live long, fulfilling lives.

References

Aday, L. A. (2002). At risk in America: The health and health care needs of vulnerable populations in the United States (Vol. 13). Wiley. com. 15-20

Bazzoli, G. J., Dynan, L., Burns, L. R., & Yap, C. (2004). Two decades of organizational change in health care: What have we learned?. Medical Care Research and Review, 61(3), 247- 331.

Cleary, P. D., & Edgman-Levitan, S. (1997). Health care quality. JAMA: the journal of the American Medical Association, 278(19), 1608-1612.

Porter, M. E., & Teisberg, E. O. (2004). Redefining competition in health care. Harvard Business Review, 64-77.