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The Medical Professionalism Blog

Show Me, Don’t Tell Me

In my experience, physicians are suspicious of health plans, hospitals and their own medical group when they hear talk about controlling costs of care. They immediately equate controlling costs with sacrificing quality and doing less for their patients. How can we get physicians involved in the issue of controlling costs without having them jump to these conclusions?

In his recent article “Lost in Translation:  Physicians’ Struggle With Cost-Reduction Programs” published in the Annals of Internal Medicine, Howard Beckman, MD addresses how a common language among health plans and physicians facilitates respectful communication about the redesign of care.  Knowing Dr. Beckman personally, I believe he is a wise man that understands the importance of respect, honesty and transparency as prerequisites for all types of relationships. This is the real power of his article.

To better define this “common language,” the ABIM Foundation has been conducting focus groups, polls, and interviews to determine how physicians think about their professional role in improving health care and as stewards of resources. Long story short, physicians are interested in improving their performance if it benefits their patients and their own well-being.

But after reading John Toussaint’s book On the Mend: Revolutionizing Health Care to Save Lives and Transform the Industry, I wonder if this emphasis on finding the right words is misguided.

In his book, Toussaint — CEO of ThedaCare, a large integrated system in Milwaukee and surrounding areas — does speak about the importance of respect for physicians and the entire health care team but he also describes the results of implementing a “lean thinking” discipline.

By simply eliminating steps in the processes that did not add value for patients, waste was removed in the delivery system. The results? The “Triple Aim” of improved quality, lower costs and improved patient experience. No fancy language or research necessary.

Toussaint’s example proves that physicians are on board with quality improvement and eliminating unnecessary services if they improve patient care and make their work life better.

For those of us concerned about controlling costs, it’s an important lesson to take to heart: Positive change results from the “show”, not the “tell.”

2 Comments to Show Me, Don’t Tell Me

  • June 20, 2011 at 4:48 pm | Permalink


    A couple corrections and a comment. I was the CEO of Thedacare an integrated delivery system in Northeastern Wisconsin headquartered in Appleton. I now am the CEO of the Thedacare Center for Healthcare Value a not for profit that is focused on redesigning care delivery and payment systems while making performance transparent.
    My comment is the work of lean thinking is trying to identify value from the perspective of the patient and then designing a new care process that removes all the non value added steps in the care delivery process. But what we also have learned is clinicians have to be fully engaged in this redesign. One way to make that happen is to use lean tools to fix some of these workers big problems. Once you fix the doctor’s biggest headache they come back for more and eventually get engaged in identifying and solving problems themselves.

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