Sometimes the simplest things are maddeningly complex.


Like many people, I have a remote garage-door opener attached to the visor in my car. It’s very old, and the battery finally gave out. No problem. Changing a battery is not such a demanding process. I figured that even if the battery were of some obscure type, I could match it in a store or, worst-case scenario, on the Internet.

So I took the device off the visor and set about opening it to remove the battery. But I couldn’t open it. I found the seam where the two major parts meet, but couldn’t pry them apart. 

I brought the device into the house where there was more light. Still no luck. I tried a screwdriver. Nothing. Then I did what I should have done earlier: I gave it to my 17-year-old son. He couldn’t open it either. Nor could my wife, who makes her living working with electronics.

At that point, I was considering using either my teeth or a hammer, but managed to restrain myself. 

Health care is full of examples of seemingly simple activities—estimating patient financial responsibility, determining the cost of a procedure—that are deeply complex. That’s also true for the system as a whole. 

In health care, our goal should be to keep people healthy and, if they become sick or injured, to return them to health in the most effective, efficient way. Sounds simple. But the barriers to accomplishing that goal are daunting, according to Don Berwick, MD, in an interview with hfm this month. Berwick—who is president emeritus and senior fellow of the Institute for Healthcare Improvement and former administrator of the Centers for Medicare & Medicaid Services—says that just  removing waste from the system requires tackling “overtreatment, failures to coordinate care, unreliable execution of care, administrative complexity, pricing failures, and fraud and abuse.”

Another challenge is a payment system that does not always support the goal of effective, efficient health care. Berwick tells a story of a meeting of senior executives at a large health system sharing great success in preventing elective c-sections before 39 weeks, which in turn reduced NICU use substantially. “Someone reported this dramatic number, resulting just from the one care improvement, and the CFO said, ‘But I have to pay for the new wing.’ It was a joke, but what he meant was: ‘I’m trapped in this old [payment] system…’”

Yet Berwick is optimistic, as long as all parties embrace a clear vision of health care. “If we all share a view of the health care we want—seamless, coordinated, patient-centered, free of waste—and then ask ‘What’s my role in that?’ we can get the job done.”

I am less optimistic about my ability to overcome the complexity of changing the battery in my garage-door opener, which continues to sit on the kitchen island. Well, if we can transform the healthcare system, perhaps I can get a new garage-door opener. 

Publication Date: Wednesday, May 01, 2013

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