Our organization, like most health care providers, is working hard to improve the care we provide to our patients, while also striving to improve the lives of our physicians. All too often, a narrow view of the former can create conflict with the latter. For example, a reductionist view of clinical quality, which equates good care with performance on a small number of “objective” measures like mammography rates and hemoglobin A1C levels, is often dispiriting for physicians. Of course physicians understand the importance of breast cancer screening and glucose control in diabetes. But they also understand that there is much more to good care. They are justifiably demoralized by the implicit devaluation of the human connections between patients and doctors – the very essence of good care — that these measures can’t capture.
On the other hand, I believe that improving a lot of the processes faced by patients and physicians outside the exam room would benefit both. For example, easing the burden of insurance paperwork, facilitating sharing of medical records among different clinicians caring for the same patient, and minimizing the intrusion of the electronic medical record into the clinical encounter, would improve the experience of patients and free physicians to have more (and higher quality) time to spend with patients.
Finding these opportunities becomes easier if we focus on the core “product” that health care organizations are “selling” to patients: the connection of patients and doctors. Instead of intruding on that, we ought to be systematically improving everything around that, from how appointments get made to how bills are paid, all so that physicians have more time to spend being doctors, and patients have fewer barriers to access care.
Here’s an analogy that I think can help. My wife and I have a subscription to the New York Philharmonic. There is no question that the “product” is the music, and the experience that concert goers enjoy. In order to facilitate that experience, which, like a medical encounter, can’t be rushed (or made more efficient), is deeply personal, and depends on the superb professionalism of the performers, the Philharmonic has created a great customer service experience outside the concert hall. They have an informative and easily navigated website, easy access to live help when you need it, and a simple process for renewing your subscription or exchanging tickets. No attempt has been made to change what the musicians do, and that is where the magic happens.
Let’s stop trying to change what doctors do. Instead, let’s take a note from the Philharmonic focus on what surrounds the clinical encounter to make it easier for physicians to do their magic too.