Steven Spear: Reengineering American Health Care



health care is a huge sector of our economy approximately 1/7 and one of the problems is as essential it is to our well-being healthcare costs grow far faster than any other part of the economy and really run the risk of crowding out all sorts of other demands on scarce resources so I guess the question why do they grow so quickly now I think we all have a familiar experience of buying a toy for a child getting the box home and then discovering some assembly required and is actually a parallel to the healthcare situation because when we get the Box home we've got all the parts but we don't have a system and it's the assembly of the parts into a system which creates the fun for the kid and healthcare is very much a non system where there's a lot of parts but they don't come together well and it's for a variety of very good historical reasons that doctors and nurses and pharmacists train within disciplines and get great expertise within those disciplines and continue your practice and reinforce those disciplines but what's missing from healthcare is practicing those disciplines in service to a system much larger than the individual expertise now as someone at MIT studied engineering things about system engineering this is a classic system engineering problem is everything about how engineers have addressed exactly the same problem they've solved on it and over the last many decades so students still come in desirous of being an electrical engineer computer scientist mechanical engineer whatever else that happens to be but they understand from freshman year on that is deep in as profound their expertise within their discipline their discipline as an individual is best expressed in in design and creation of systems much larger than themselves and in fact the the MIT experience is that a lot of the value we create is not just within departments but it's within labs and centers where people with many different disciplines from many different backgrounds come together so healthcare right now is lacking that system thinking but it's perhaps solvable and I think they're probably two or three major triggers on this so one is providing healthcare with the motive to do the integration and worry about how the pieces come together so currently what we do is we will award individual practitioners for individual activities what we don't do is pay and measure and reward on the experienced patient has going through all the different touch points across all the different disciplines so there's the motivational measurement piece and then there's the practice piece so right now when our engineering students come in they train and they learn within departments but then they have projects and other activities and other experiences which are cross-disciplinary currently missing but which would really be essential to help healthcare move along is that doctors and nurses and pharmacists not only train within their specialty in their discipline but part of their training is done cross functionally entered interdisciplinary so they understand how the pieces come together in the system when their junior had to express their expertise in a system and as they get more senior actually how to manage systems both to design them and operate them and then finally to improve them

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