Thursday, 27 of October of 2016

Category » Healthcare

Healthcare, critical thinking, and points of view

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One of the harder aspects of critical thinking is to be willing to accept that your point of view is only one of many points of view addressing a particular situation and that they are just as real as yours . You may not like them; you may disagree; but they are real.

The challenge you face is to consider them and take them for what they are – legitimate expressions of concern. If you ignore them, you are guilty of lazy thinking.

Consider our health care system and the many points of view that need to be considered by those attempting to improve the system.

  • To people with good company paid insurance, the system is just fine and they see no need for change.
  • To the uninsured, the system is divided into “haves” and “have-nots” and all that they know is they are not even in the system.
  • To insurance companies, the system is part of a business ecosystem and they know that they have to keep their shareholders happy with decent profits.
  • To a Medicare recipient, healthcare is a promise from our government for a lifetime of work.
  • To a patient with long-term illness, the system is slowly driving them into bankruptcy.
  • To a healthy young adult, the system is something they may need sometime, but not right now.
  • To a hospital executive, the system is overly complicated and rife with administrative duties.
  • To a doctor approaching retirement, the system is the reason to give up a lifelong passion because it’s “just not worth the hassle.”
  • To a conservative, the system has no need for government.
  • To a liberal, the system needs government involvement.

And on, and on, and on.

Take a look at our healthcare system and consider some of the points of view.

Now, without falling back on a predisposed ideology (which is a single point of view) consider actions “we” could take to improve the overall performance of the system.

Not so easy, is it? How would you like to be an “independent” in Washington? Must be lonely.

We need people who will think about the problems with health care, not simply use ideology to drive their position.

What do you think?


Healthcare and Critical Thinking — using the concept of nested boxes

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Concepts help active critical thinkers organize their thinking. Sometimes the simplest of concepts work the best.

Reflect on the reality of workers in the healthcare system. I don’t care who you think about – it could be a doctor, a nurse, a technician, or an administrator. These workers are talented and dedicated and eager to do the right thing (most of the time). However, they “live” in the smallest box of a series of nested boxes.


It would be wonderful if the boxes fit in perfect alignment. However, the reality is more like:


Leaders at all levels in the system should be searching for answers to the following questions:

  • How will the economy (and its slow recovery) affect the healthcare industry?
  • How will your company respond to changes in the industry?
  • How will jobs have to change to respond to changes in company strategy?
  • Will the leaders and the workers have the skills needed for the job changes?

Most of the workers “in the trenches” simply want to do a good job, feel satisfaction, and have security. It’s up to the leaders in the government, the industry, the hospitals, the companies, etc. to make sure the people actually doing the work know why their jobs have to change.

Think about the turmoil surrounding healthcare; think about nested boxes. This is “creative destruction” at work and the system WILL (eventually) realign itself. What “pinch points” can you forecast as we reflect on the reality of changes to the system? What


Health Care and Questions in Search of Good Answers

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Great thinking is built on great questions. Unfortunately, it seems to me, we have started with answers before we agreed on the important questions.

One of my favorite books is Asking the Right Questions: a Guide to Critical Thinking by Browne and Keeley. Let’s see how a few of their questions help inform the discussion about health care

  • What are the issues and the conclusions?
    • Let’s stick with the issues from the last post: coverage, quality, cost, and choice. We are still wrestling with the conclusions about each of these issues. Coverage seems to be the big Democratic issue and a conclusion for many is that coverage needs to be universal. Cost and choice seem to be the big issues for the Republicans and tentative conclusions are that cost will be too high and that choice is important and will be hurt by a “government” agency.
    • Bring this down a notch and look at it from the perspective of a hospital executive: universal coverage is good; high quality is demanded; cost should “reasonable;” and choice may be bad if it adds to administrative costs.
  • What words or phrases are not clear?
    • Do we have common understanding of: “rationing,” “free market,” “recission,” “Obamacare,” “level playing field,” “socialism,” or, for that matter, “health.” Think back to the days of the “quality” movement – lots of discussion by what we meant by quality.
  • What are the value conflicts and assumptions?
    • Is the healthcare system run as a “zero sum” game. Does one party win at the expense of the other? Unfortunately all of the public “debate” has focused on differences and not common ground.
    • What line items should be used in a healthcare system report card? Until we have a common set of items we can cherry pick “the best system” to fit our needs.
    • There are a bunch of assumptions that have to be investigated: Will quality reduce cost (like it did for manufacturing)?
  • How good is the evidence?
    • There are bits and pieces of evidence floating around, but little has been used in coming to terms with the debate.  Furthermore, when numbers are presented they are not always put in proper context nor made widely available.
    • What evidence would you want to see to come to grips with the issues of coverage, quality, cost and choice?
  • Are the statistics deceptive?
    • The short answer is Yes. We have to make sure we understand the basis behind the numbers.

We have a lot of very smart people who can find answers once we have posed the right questions. From your point of view, what are important questions that no one seems to answer?

Do your comment

Healthcare, critical thinking: defining YOUR issue

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The foundation to good critical thinking is coming to grips with the issue at hand. Saying that “the system is broke” is meaningless until you define system and all of its components. To rail against “Obamacare” is meaningless unless you can explain what you mean by Obamacare. So, what’s the issue?

I’ve been reading T.R. Reid’s excellent overview of healthcare, The Healing of America, wherein he compares healthcare in Germany, France, Japan, the U.K., Canada, and the United States and his framework is very instructive for considering “the issue” about healthcare. His framework is composed of four factors: coverage, quality, cost, and choice. With just these four words, you can start to better define some of the many issues.

  • For the 30 to 45 million uninsured, it really is all about coverage. However, for the business owner coverage means added cost.
  • For the well-to-do, or the retired person pondering Medicare Part D, it may be about choice so as to maximize benefits. However, for the insurance company with a near lock on a state, choice is the last thing they want.
  • I want to know exactly how much an operation is going to cost, but my doctor has no way of knowing until after the fact!
  • All of us want “the best” but someone (“not me”) has to pay for it.
  • And on, and on, and on.

And here is the nasty part of trying to define “the issue.” We can be pretty sure that some blend of the four factors is going to change. We just don’t know what the blend will be.  So what is a healthcare executive to do? As I said in response to an earlier post comment, the answer is not to stand still and react after-the-fact.

Whether you are a hospital exec, an insurance exec, a doctor, an employer, a supplier or an individual the issues are explored and defined by knowing what is in your control and what is not and then determining what it will take to remain viable as the system changes. Here are some hypothetical responses to possible futures of healthcare. Consider the plight of a hospital exec if…….

  • Universal coverage is enacted – How much will ER capacity and staffing go down if patients see docs earlier?
  • Electronic medical records are legislated to improve quality – How many older docs will take retirement rather than make the change?
  • Patients can choose from hundreds of insurance funds – How many billing clerks will have to be added unless standardized forms are used.

You get the picture. We know the system will change. We don’t exactly know what will change. It’s a human tendency to wait – but that may be too late.

OK, I’m not foolish enough to think that healthcare executives are reading this blog. So let’s make it personal. MY issue with healthcare is simple – since my wife and I are on an individual policy and can be dropped or priced-out if either of us dare to get too sick, our actions are to exercise and eat healthy and hope Medicare is there in a couple of years. It’s my responsibility to stay out of the system, because I know I can’t afford to get sick. Depressing, but true.

See if you can define YOUR issue with healthcare. They say that all politics are local, and nothing gets more “local” than health. Consider Reid’s factors of coverage, quality, cost and choice.


Healthcare and critical thinking

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My last post considered ways to think about the healthcare system and I offered five snippets addressing ways to think about the future of the health care system. The fourth of the five snippets was a simple statement to “think critically.” Easy to say; hard to do.

This is the first of eight posts that will take a deeper look at that simple piece of advice. Today I’ll provide an overview of seven components of critical thinking and in subsequent posts I’ll dig deeper into each of the components.

I’ve decided to focus on health care for a few reasons: (1) it’s REALLY important to a lot of people; (2) the “debate” has been highjacked by people (left and right) with very strong opinions who do not want us to actually think about healthcare, just follow their line of thought; and (3) I’m having a hard time getting my mental arms around this issue and feel that maybe a little writing will help me clarify my own position. I need your help here.

CRITICAL THINKING: It’s the process of figuring out what to believe and then what to do about your beliefs. It starts with “figuring out what to believe,” which takes time and is darn hard work. It’s easy to parrot a talk-show host; it’s uncomfortable to examine your own beliefs and figure out if they are built on a good foundation.

As you work on figuring out your beliefs, here are seven components of critical thinking to consider:  

  • What’s the ISSUE and how does the issue look from various points of view. From a moral perspective do you believe that everyone has a right to quality healthcare? From a fiscal perspective, who should pay for this right? For that matter, what about our individual responsibility to live a healthy lifestyle. Should I pay for your smoking habit and should you pay because I like to eat a lot? Paying for the system has come front and center, but it’s not the only issue. Step One of critical thinking: get clarity about the set of issues and work at prioritizing them.
  • What QUESTIONS bring clarity to the issues? And the most important question to ask is: Are we solving the real problems? With upwards of 90,000 people dying every year because of mistakes, misuses, and care-acquired illnesses, is the main issue about payment or quality? We have LOTS of smart people who can answer questions. Are we asking the right questions?
  • What CONCEPTS are we using to organize our thinking? I’ve had healthcare executives (angrily) tell me that “We are not a factory making widgets!” True. But the concept of standardization seems to work in every other industry. Might it be applied to some of the issues affecting healthcare? Concepts help us organize our thinking and then explain it to others. What’s your concept of a hospital? (Remember, in the late 1700’s they were literally “a place to go to die.”)
  • As we think about the health care system what are the ALTERNATIVES to today’s practices? The general hospital was right for medicine at the beginning of the 20th century because it did everything for anybody. A hundred years later is it still the right way to deal with injury and sickness? For that matter, what are the alternatives to staying healthy and never having to use a hospital?
  • ASSUMPTIONS are the foundation of all strategy and all plans. And when assumptions degrade, the plans are usually out of line with reality. What assumptions underpin the insurance industry? What assumptions are the foundation of the “medical home” concept being touted? What assumptions are employers making about their role in keeping employees healthy? What assumptions are you making about your health needs as you age?
  • “Truth” often depends on your POINT OF VIEW. What does the system look like from the point of view of a retiree who is in the Medicare system? What does the system look like from the point of view of the owner of a small business? What about a self-employed bloke like me? Who’s right? All of us. Who’s wrong? All of us.
  • As I write this all I know for sure is that Congress is going to do “something.” Not sure what it is; but I do know that whatever they do will have both intended and unintended CONSEQUENCES. People following an ideology tend to see the intended consequences of their actions and “get surprised” by the unintended consequences.  All of us should think about “what else” were getting when we take an action. It will play out – but later.

HELP!  I really want to get my arms around this and I need a conversation. Please comment – challenge – add-to – etc. Please pass this on to friends and colleagues who are in the system. What does it look like from the inside?

(Jodi, if you’re reading this it’s time to comment.)

OK, now it’s your turn.