Designing a New Health System

Dear Physician and Office Staff:

For the last 20 years, Harris Interactive has polled doctors, hospitals, health plans and the public about their attitudes toward the health system. According to the results of these polls, not only have attitudes become increasingly negative, there has been a convergence in attitudes among all of these players. No more than one-sixth of the public today believes the system is OK as is or with minor changes — and four-fifths believe that either major change is needed or the system needs to be rebuilt. Almost twice as many consumers believe that “We need to
completely rebuild the system” than other respondents, who still believe that “Fundamental change is necessary.”

These findings remind me of a popular saying in the quality-improvement movement: “Every system is perfectly designed to produce the results it produces.”

In other words, if you want different results, you have to change the system. Individual performance — merely working harder at the same things in the same way — is usually not the answer.

There are three keywords here. The first is “system.” All of us work in systems, whether we are in big bureaucracies or solo practices. Effectively solving our health care problems requires us to think of our work environment as a complex network of interrelating, interdependent parts. The relationships and processes that make up the system are what make the difference — not the system’s separate parts, including the individuals working in it.

The second is “design.” Most of the systems in health care, whether in physician practices, in hospitals or in health plans, were not consciously designed. They evolved. What we tend to call “system redesign” in health care is usually first-time design. The key to successful design is to build the system specifically to achieve the results that we want — healthy, satisfied consumers.

The third key word is “change.” If we don’t like the results we’re getting, we must change what we’re doing.

At Humana, we’ve launched Integrated Consumer Experience (ICE), an initiative that is leading us to rethink the core processes that have the greatest impact on the way consumers view the system. We’re in the midst of thoroughly mapping the way our processes affect consumers so that we can redesign our processes to achieve better results for consumers and, we think, everybody involved.

We’re convinced that systems that are designed around the needs and preferences of consumers and that are respectful enough to allow consumers to act on their own preferences will produce much better results — and much higher satisfaction — than the systems we’re all struggling with today. We’re hopeful that in the next few years we’ll be able to see a reversal of those polling numbers and a more satisfying system for all involved.
Sincerely,

Jonathan T. Lord, M.D.
Chief Innovation Officer

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