Professor Ezekiel J. Emanuel – oncologist and the vice-president of the Bio-Ethical Institute at Philadelphia University – presents the deep crisis facing the American health service in stark terms. His Prescription for the Future 1 is based on his research as a physician and his experience as a senior advisor to the design of the Affordable Care Act (“Obamacare.”) The program, which is consistent with the principles of Lean Healthcare, operates on two levels: the national (macro) level and change in the views of management at the institutional (micro) level.
In meetings with the directors of hospitals and senior representatives of the Ministry of Health in Israel, which took place in at the Assaf Ha’rofeh Medical Centre, Emanuel presented the root causes of the illnesses from which the American medical system is suffering and outlined possibilities for its redesign. Coping with the crisis in the medical systems in the OECD necessitates bridging over the widening gap between the accelerated growth in the demand for medical services and the limited resources with which the health system and institutions must provide appropriate solutions for the public’s needs.
Breakthroughs in medical technology, gene research, artificial intelligence and the quality of medications have the potential to extend the quality and length of life – but currently, this is available only to the wealthy. The growth in chronic diseases (including old age) has redefined the methodology of medical care and management of health system. Spending for health and medical services is a major part of the family, national, and international budgets, and the dramatic increase in their costs presents policy makers with economic, social, political, and ethical dilemmas.
The danger facing someone who is hospitalized in a sophisticated hospital in a developed country is hundreds of times greater than the risk posed by driving. In 2013, the State Comptroller published a scathing report that exposed the high levels of infections in Israeli hospitals (in a particularly bad year, some 400 Israeli civilians are killed in traffic accidents.) According to the comptroller’s report, between 4,000 and 6,000 people die of infections contracted in the hospital annually. If we add to this the incidents of deaths caused by human error, the numbers will be even higher.
The image of the “old lady in the corridor” and the overload on emergency rooms are perceived as inevitable problems with which government policy, the regulators and the management of medical centres cannot cope. The organizational culture based on “traditional management”, along with operational principles gleaned from methods of mass production have been part of hospital culture for a long time. Essentially, “traditional” principles of management still hold sway in the public and commercial sectors, even though they have long been shown to be irrelevant. But with regard to the medical system, the price is much higher.
It is disheartening to find that the systematic scientific thinking and professional courage found in medical research has yet to penetrate the managerial and leadership levels in medical institutions. The prevailing managerial attitude, along with the fear of exposing errors (and learning from them), allegedly stemming from the “concern for human life,” force well-intentioned managers into conservative ways of thinking, innovational stagnation, and managerial incompetence. Since, in contrast to business organizations, medical centres are too big (and too important) to fall, the wave of awareness that is rushing over increasing numbers of business enterprises is blocked at the entrance to the medical system.
The central questions facing anyone who wishes to change the managerial paradigm in the medical system are: What are the values, mindset and vision according to which an effective medical system should be designed? How can the basic assumptions of the traditional administrative paradigm be replaced with up-to-date views of management? How can we enlist medical staff in a broad effort to change the existing organizational culture?
To review Zeke Emanuel Keynote:
Boaz Tamir, ILE.
1Ezekiel Emanuel, “Prescription for the Future – The Twelve Transitional Practices of High Effective Medical Organization, (2017), Public Affairs, New York