A Common Sense View

What do we know about effecting real and lasting change in healthcare performance? How do we capture a return on efforts that produce value (higher ratio of quality per service unit cost) that is meaningful to our customers and patients? We’re confounded by the cacophony of consultants that offer the newest and latest coffee table text solutions that cause our staff to tuck their heads into their laps and wait for the ill wind to blow over so they can get on with their jobs. Have you been around long enough to have tried Total Quality Management, Continuous Quality Improvement, Malcolm Baldrige, Toyota Lean Production, Quint Studer, or Six Sigma? If you’ve answer yes to any one of these, you’ve got the passion to seek solutions to complex problems and likely the discipline to effect real change, but are you satisfied that the breakthroughs have actually happened? For most of us, the answer is no.



In the aggregate, we do know that many many individuals and organizations in the healthcare industry are trying (sometimes desperately) to improve the situation. We certainly know the pressure to change is enormous. Yet, for all our good efforts, sustained reduction in costs and/or improvement in quality (perceptible at the level of our patients and customers) remains, for the most part, elusive. Brenda Zimmerman writes about complex systems in her book “Edgeware” and comes to the conclusion that all these tools are good and useful, yet overlaying this must be simpler organizing principals that drive improvement despite the overwhelming complexity of the systems we work in and on.



In a recent Wall Street Journal Opinion Page article, Jason L. Riley cuts to the essence of our point [WSJ 8-21-2006, “Malaria’s Toll”]. “Each year, malaria afflicts about a half billion people (roughly the population of North America) and kills a million of them (roughly the population of San Jose). And the latter is a low-end estimate.”…the tragic incompetence of the Western foreign aid industry - $2.3 trillion spent, over five decades, but little forward advance – stems from its overly bureaucratic approach to problem-solving.” In a refreshing, common sense approach to the malaria dilemma, enter Lance Laifer. Lance is not a U.N. malaria specialist, rather a hedge fund manager with a ton of common sense. He is what Mr. Riley terms a ‘searcher’: a person who understands complex problems and prefers to tackle solutions one at a time, case by case, using trial and error…moreover, with the keen understanding that tailored solutions are required for complex problems and the practical work is, by definition, homegrown.



We couldn’t agree more.