Modern management theory sees the operations of organizations as systems. In such a view, the approach is to understand goals, improve processes, model behaviors, monitor performance, and otherwise create a mechanism that can be directed and controlled. Get the mechanism right and executives and managers can steer the organization closer to realizing its goals.
That is a simplistic description and one that suggests an orderly and efficient approach. Reality is always messier. Building the right models, avoiding addition of systemic mistakes and errors, and even ensuring adherence to the goals and underlying values of the organization is difficult. In fact, the mechanistic and systemic approach can lose a sense of humanity and fall out of touch with what an organization should be doing. That’s happened in healthcare, according to Dr. Nortin Hadler, author of By the Bedside of the Patient, as described by Dr. Edward T. Chory of Lancaster, Pennsylvania. The overall message is that technology and this systemic approach to healthcare are undermining the essence of healthcare.
This is a vitally important concern. Dr. Hadler has long been a critic of “overtreatment.” He describes the evolution of the American healthcare system from individual practitioners and hospitals — that did little but allow patients to rest and escape the environment that quite possibly was responsible for their illness or, at the very least, was contributing to it — to the cathedrals of science and technology of today.
The institutions are now coalescing into megasystems involved in an ever-accelerating arms race to provide CT scans, MRIs, linear accelerators, gamma knives, cath labs and interventional units with stents for every artery from coronary to aorta, not to mention the latest generation surgical robot.
Any system can go awry, and, according to Hadler, increasing amounts of capital and human effort are poured into administration, documentation, data collection, technology, and a dizzying number of treatments.
The challenge for good executives, managers, and administrators is to understand how efforts to do what is right for the organization can have the opposite effect. Yes, data is absolutely necessary to monitor operations. But is more data necessarily better? It is possible to drown in information that is not relevant to what you are doing, meaning that you have created costly make work.
Documentation is also important. But at what point to you cross from knowing what happened into an area of purely saving face or pre-arranging blame? And when do additional tests and procedures move from treatments to ways of countering legal liability or even methods of increasing billings? Managers need to be wise, not just smart, and understand how and when to use common practices.
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