Cost Is the New Quality; Waste Is the New Cost
by Win Whitcomb, MD, MHM
Hospital medicine has never been bashful about stating its goal to be a financial steward of the most expensive place in our healthcare system—the hospital. At the first gathering of hospitalists in April 1997, the newly formed board of directors debated whether we should promote efficiency as a primary goal of the organization and, by extension, our field. We drafted as the first line of our mission: To promote the high-quality and cost-effective care of the hospitalized patient.
Now, as the cost of healthcare approaches 18% of our nation’s gross domestic product, the jobless rate remains high, and the economic recovery underwhelms us, the emphasis of many thought leaders has shifted to cost as the single biggest barrier to ideal healthcare in the U.S.:
I agree with Don: Sure, the other dimensions of quality healthcare—that it be safe, timely, equitable, effective, and person-centered—are critical. But now, efficiency is king. Looking ahead, it will require singular focus.
The problem is, who can get excited about reducing costs? (Don’t all raise your hands at once.) Well-meaning clinicians, when asked by healthcare administrators to order fewer tests or use cheaper drugs, shrug their shoulders and assume it is a ploy for the hospital or health plan to bolster profits off their backs. Or we simply feel that we have better places to focus our efforts. After all, ours is a noble profession, not a bottom-line-focused guild.
The thing we can get excited about is reducing waste. We see waste every day and have the genuine wish to eliminate it. As an example, the Lean practice—borrowed from manufacturing—is a widely used tool in healthcare. Its primary focus is the recognition and elimination of waste. Lean recognizes as many types of waste as Eskimos have words for snow.
Dr. Berwick went on to outline six areas of waste in healthcare, at least three of which fall squarely on the shoulders of hospitalists:1
The other three (administrative complexity, pricing failures, and fraud and abuse) are for another day.
What can we do immediately to reduce waste? At a high level, HM should take on the waste challenge the same way it confronted quality and patient safety. We have had an implicit waste agenda, at least in terms of efficient hospital throughput. Now we need to make that agenda explicit, and be clear that our focus on length of stay, costs, and avoidance of overtreatment is what is needed for our patients and our system. We need a framework for moving forward, and we need leaders from our ranks to build it out.
In the meantime, let’s go to work tomorrow and implement change in the three areas Dr. Berwick mentions. He believes in us. So do I.
Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at email@example.com.
The Hospitalist newsmagazine reports on issues and trends in hospital medicine. The Hospitalist reaches more than 25,000 hospitalists, physician assistants, nurse practitioners, residents, and medical administrators interested in the practice and business of hospital medicine.