Imagine you want to watch the big game this weekend, and your TV dies. So you decide to buy a new TV.
Everyone recommends the same place and the same salesperson, Ray, but you have to get an appointment with him because he’s so busy. Fortunately, the store lives up to its reputation and manages to fit you in today. Ray is incredible and finds the perfect TV for you. But his store only carries the screen.
Ray calls the other TV experts in town, and you return home with all the TV components you need. But now, you’re faced with a pile of parts and no user’s manual on how to assemble them. You’re frustrated, but eventually you end up with a functional TV.
You got the outcome you wanted. Everyone provided great service, but the entire process was painful. And once you were going down the path to gather all components, you had no idea what the total cost would be in the end.
We do the same thing in health care, says Amy-Compton Phillips, Executive Vice President and Chief Clinical Officer for Providence St. Joseph Health. “We have a system that’s hard to shop for care, it’s hard to purchase care, it’s hard to buy what we want, and it’s hard to use. And so our goal when we redesign care is to rethink that process, to flip it on its head and make care that’s easy to shop for, easy to buy, and easy to use.”
Easy to shop. You might think that with the Internet and websites like Yelp, we’ve already fixed the easy to shop problem. But, says Compton-Phillips, those help with the experience of care, or the service, like the TV salesperson bending over backward to get you what you want. “That’s not about the problem that you’re trying to solve for in health care,” Compton-Phillips says.
For example, a patient advocate on the board of ThedaCare, who was pregnant, found out that her baby had a congenital heart defect that would be lethal if it wasn’t fixed surgically at birth. When shopping for the right surgeon for her baby, she wanted to know surgical volumes, mortality rates, whether the heart valve fix would grow with her child or if there would be additional surgeries in the future, and whether she would be able to take her child skiing in the mountains. She went online for this information and found nothing. With the exception of a few forward-looking organizations, such as Cleveland Clinic, we don’t yet have outcomes information that tells whether we are solving the problems patients care about.
Easy to buy. Compton-Phillips shares the example of her father-in-law, who was fairly healthy when he died in his sleep. And yet, over the last 100 days of his life, the amount of billing statements he received amounted to 90 pieces of paper. “I have no idea what we paid for or what Medicare paid for. I have absolutely no idea what care we purchased that made his life better. [If] it’s not intelligible to me, it’s not intelligible to anybody,” says Compton-Phillips. Hoag Orthopedic Institute is an example of doing things differently — they put the prices of an entire bundle of care online, along with outcomes information, that way you know the value of your care.
Easy to use. There’s no user’s manual for health care. And for patients, not knowing what to expect next can be emotionally traumatic. “And if you don’t know what to do next, you don’t know how to change it to make it better for yourself,” notes Compton-Phillips. “You lose control. You take away your autonomy and you don’t have a path.” We need apps that help put control back into the hands of the patient, such as Providence’s Circle app for pregnant women, which outlines care paths and describes how you can change your outcome if you go off that path.
“Patients want health. We supply health care. Health is the problem. Health care is the solution,” says Compton-Phillips. But there are many solutions to a problem.
“What I hope we focus on as we enter into this age of high-value health care is that we design systems that really are easy to shop for, easy to buy, easy to use — and that solve for health.”
From the NEJM Catalyst event The Future of Care Delivery: Relentless Redesign at Providence St. Joseph Health, January 19, 2017.