Three Reasons the General Public Doesn’t Think Health Care Can Improve

Lean thinkers see the waste in health care when they are at the hospital gemba. I think this is true whether you are a lean person who is new to health care or if you’re a long-time hospital person who has learned lean. Experts (doctors) ranging from John Toussaint to Patricia Gabow to Don Berwick all estimate that between 30 to 50 percent of health care spending is waste.

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It seems that, often, when you take this sort of discussion to the general public, people react emotionally as if “reducing waste” equates to not providing people the care they deserve—they think lean health care is about taking away, instead of reducing cost and improving quality. I think this happens even outside of charged political circles. Why is that?

I have a theory.

Some of the common waste is described in this article about a new Master’s Degree program at Dartmouth:

“Disney knows precisely how to gauge the wait for rides at its theme parks. Major airlines know how to maintain near-perfect safety records on their aircraft. But hospitals? Most don’t know how to avoid making patients wait—some just build bigger waiting rooms.

“Medical centers spend increasing amounts of money on patients, but don’t necessarily deliver better care.

“And estimates suggest that each year in the United States there are 15 million incidents of medical harm, some of which result in injury or death.

“Now, a new master’s degree program at Dartmouth College is intended to bring more of the business of safety, cost-effectiveness, and efficiency into medicine.”

My theory is that the general public puts a lot of faith in our health care system. Blame TV or the movies, I guess. Would they think that a program such as Dartmouth’s is even needed?

I think people find it hard to believe the 30 to 50 percent waste estimates because they assume health care is fundamentally pretty perfect, or that it should be. It breaks down into three categories… because we have the following, we should already have perfect waste-free health care delivery:

1. We have highly trained, motivated people who care a great deal about patients

2. We have relatively new, modern hospital buildings

3. We have amazing health care technology (equipment, software, and medical knowledge)

 

So what could go wrong, given those three aspects? Yet, lean thinkers know that the overall system just doesn’t work. It’s probably hard for the general public to see that 1+2+3 = a lot of waste when they would likely assume 1+2+3 = awesome.

So when errors occur, the general public wants to blame and punish individuals—assuming they must be bad people working in an awesome system. When cost is high, people want to blame the greedy or the incompetent. People tend not to look at the overall system, they wouldn’t expect the problem is bad processes, not bad people. The general public assumes quality is good, when the data show otherwise.

It’s safe to say there are indeed a lot of great aspects about modern health care (see 1, 2, and 3, above). But we don’t get the high quality and patient safety we deserve and we, in the United States, certainly spend way more than we have to—and this high spending is partly due to waste, not due to 1, 2, and 3.

Do you think the public shares that perspective that I described above? Does that common (and arguably incorrect) view get in the way of the public calling for real systemic improvement that reduces cost and improves quality and safety? If so, how can we change the perception that 1+2+3 automatically equals awesome?

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