Rescuing Healthcare: A Leadership Prescription to Make Healthcare What We All Want It to Be by Antony Bell and Denis A. Cortese, MD. Morgan James Publishing. New York. 2017.
There is widespread agreement that American healthcare is in trouble. There have been many efforts to fix it. We have researched it and thrown money at it, but nothing has made a substantial difference. Perhaps, we need a revolution! The authors of Rescuing Healthcare: A Leadership Prescription to make Healthcare What we All Want it to Be are convinced that the solution to our crisis is having the right kind of leadership. This book preaches that such leadership is possible. The book begins with an examination of how we got into our present disastrous system – described as having out-of-control cost and being of poor quality. The obvious answer proffered for this problem is to provide the highest value at the lowest cost. The current system focuses on processes rather than outcomes, on the individual procedures rather than the whole treatment cycle. The critical piece in this solution is the right kind of leadership.
The right kind of leader, whether a provider, a policy maker, a regulator or another stakeholder, must get people to agree on a clear common purpose and a clear shared vision – something that has been missing in the many debates about our current healthcare system. Then there has to be a strategy to develop a culture, a skill and a technology to implement the necessary changes. There must be a healthy and constructive interface among the main domains of healthcare.
Quality in healthcare is dependent on outcomes + safety + service, while value is defined as quality/cost. Reimbursement must be totally dependent on value. We must incentivize the right things. This means thinking differently about healthcare delivery – in some cases radically. This means that some costly treatments are sometimes indicated earlier in disease management, if it avoids other treatments later. The new healthcare system must be integrated and coordinated. The patient must always be at the center of healthcare.
High value healthcare must emphasize prevention, early intervention and timely, informed care. They define primary prevention as preventing the onset of chronic disease, something we do not yet have the capacity to effect. Secondary prevention is appropriate chronic disease management and tertiary prevention is for acute illnesses. This means that the focus is away from acute care.
Leadership really matters: it is the critical variable and has been lacking. Good leadership makes the world better; bad leadership makes it worse. More than ever in healthcare, we need the right leadership with policies implemented by the right people in the right places – both leaders who set vision and strategy as well as those who execute that vision and strategy. The good news is that such leadership is possible. The authors use this book to take the mystery out of leadership and make it accessible and very practical.
So what do we have to lose? We have tried everything else and nothing has worked. So grab this book and let’s give it a whirl!