Thursday, August 27, 2009
David Goldhill’s “How American Healthcare Killed my Father” from this month’s Atlantic is the most comprehensive survey I’ve read of the current state of American healthcare, the factors that make it so complicated, and how we should be thinking about effective solutions.
The analysis develops from Goldhill’s quest to figure out how his father–and 100,000 other patients annually–could have died from infections acquired in the hospital. At 17 pages it’s about as concise as one could be while really discussing the issues thoroughly. I almost shied away from an excerpt because I really think it’s worth reading the whole thing, but here’s a frame-up:
Keeping Dad company in the hospital for five weeks had left me befuddled. How can a facility featuring state-of-the-art diagnostic equipment use less-sophisticated information technology than my local sushi bar? How can the ICU stress the importance of sterility when its trash is picked up once daily, and only after flowing onto the floor of a patient’s room? Considering the importance of a patient’s frame of mind to recovery, why are the rooms so cheerless and uncomfortable? In whose interest is the bizarre scheduling of hospital shifts, so that a five-week stay brings an endless string of new personnel assigned to a patient’s care? Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations?
I’m a businessman, and in no sense a health-care expert. But the persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.
This is precisely the way we ought to be thinking about healthcare. If we aren’t thinking critically about why the same radical innovations we see from market forces aren’t occuring in this industry, we aren’t thinking clearly about the issue.