I almost titled this blog, "The Efficiency of Delegation: What US Healthcare Can Learn From The US Military."
For those who read my blog, it will come as no
surprise that I often mention the incredible lessons learned and experience
gained during my Air Force career. I wouldn't trade those years for anything,
in no small part because my military service was the best training for a
business career to come. In the Service, the guiding principles of honor,
respect, teamwork, discipline and persistence are critical when building highly
competent teams who can take on any mission, big or small. One of the reasons
that the troops in the US military function so very well is the cultural
strategy that places enormous emphasis on effective delegation of authority to
the lowest levels possible to achieve a desired mission, and likewise, a
culture that recognizes the need for rapid upward escalation when a situation
requires it.
Recently I learned of a company called healthfinch,
which makes Care Redesign applications that bolt on to EMRs (they are best
integrated with Epic, but also working with Allscripts and will soon have
products for Cerner) to automate, delegate, and simplify clinical workflow
tasks. Currently, managing these clinical tasks, like prescription refill
requests and laboratory results, most often falls on physicians who end up
spending 2-4 hours per day sifting through hundreds of inbox messages. The
sheer volume of these non-reimbursable, routine and repetitive tasks has become
toxic to physicians, and is oft cited as a chief reason that nearly 88% of
physicians are burnt out. Ironically, as reported recently by Bain,
physicians who work in physician-led organizations are even less satisfied than
their counterparts. We are at risk of losing one of healthcare’s most valuable
resources.
As great organizations and the US military
know well and healthfinch has
figured out, delegation of tasks to the
most efficient venue of completion is the most efficient way to run an
organization. In the military, each person has training and a rank that
comes with a defined scope of authority and they are expected to execute based
on their role. Commanders set the strategy and delegate the planning to their
top brass. The top brass creates a detailed plan and then they delegate
tactical execution to the junior ranks, and so on. This workflow, in which all
parties have well defined roles based on their authority (read: credentials),
creates order, efficiency and, one could argue, ensures the safety of everyone
on the team. Would it make any sense for the highest-ranking commander to get
“into the weeds” and call in strike coordinates or type up a memo? No, and
during the Vietnam War our US military learned that the hard way.
We must think in these terms in healthcare
too, specifically regarding clinical workflow.
We need to respect the authority and training of each healthcare
professional in the “chain of command” and make sure that they are working to
the absolute top of their license—yet not above it or below it. Physicians are healthcare’s
general officers-- our chief strategists if you will-- and should be available
for managing the most complicated and high risk patients. They must be
empowered to delegate routine patient care and clinical tasks to their staff, like
physicians’ assistants and nurses. And then, those individuals must be able to
delegate further to medical assistants and health coaches. If a physician is spending
2-4 hours per day on managing routine clinical tasks, the delegation system is
broken, resulting in huge inefficiency and uncertainly in roles, staff
unhappiness, escalated costs, and poor patient care. I’ve spent a fair amount
of time in international healthcare settings the past few years, where clinical
outcomes are higher and per capital healthcare costs are much lower. One of the
common traits in these other countries is delegation of decision making and
patient care to the most efficient venue. They empower nurses, PAs, and
pharmacists, in particular, to care for patients and make clinical decisions
that the US system constantly escalates unnecessarily to physicians. Part of
the problem in the US system is the fee-for-service economic model that
encourages this escalation. As soon as we become a margin and quality-driven
economic model—and we are getting there-- I’m sure that delegation of tasks will
be more widely accepted as the norm. Over
80% of physicians now “agree” or “strongly agree” that controlling costs is
part of their clinical responsibility; we need to give them the systems and
technology to enable that.
healthfinch gets it. They see the undeniable
value and inevitable trend towards delegation and automation of tasks in
healthcare. They get a “Very Cool” endorsement from me because they are taking
delegation and top-of-license performance very seriously. Their flagship
application, Swoop™, an app that automates the prescription refill process, has
transformed workflows in many client sites. Physician inbox tasks for refills
have been reduced by 70%, freeing them up for more direct patient care. They
delegate more to nurses, who are now empowered to handle on-protocol requests
in a matter of seconds, not minutes. And patients are receiving responses to
their refill requests in less than 24 hours instead of 72 or more in a
traditional manual approval model.
healthfinch is able to accomplish these
efficiencies through automation, but only because their clients: (1) Recognize
that their staff must be given the authority needed to do the job, and (2) Safely
delegating the right tasks to the right people makes sense.
If your organization is seriously thinking
about redesigning care delivery, I suggest you talk to the folks at
healthfinch. They’ve got the right idea, and the right product, at a time when
healthcare needs it most. I think you will be impressed. Physicians will be
really impressed and relieved to see the emergence of this type of company and
product.
I receive no reward or compensation of any kind for endorsing-- or criticizing-- companies or their products, including healthfinch.
I receive no reward or compensation of any kind for endorsing-- or criticizing-- companies or their products, including healthfinch.
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