Much like an abandoned car, it appears that the two health care systems I am most familiar with (USA and Canada) have been left to rust. It may seem like a naïve question but I don’t have a clear idea of who is in charge of delivering health care innovations to patients.
I know who funds innovation — CIHR and NIH are the lead funding research agencies in their respective countries. Together with many foundations, such as Heart and Stroke, Cystic Fibrosis Foundation etc, they fund the most advanced research leading to medical discoveries that improve health and save lives. There are agencies that regulate the safety of new medical treatments — FDA and Health Canada. Once an innovative medical solution has passed the safety hurdle it needs to find its place in the provincial formularies (Canada) and obtain a reimbursement code from the insurance providers in the United States (that one step takes on average ~ 2 years).
There are visible efforts to improve system’s capacity, such as the Ontario Ministry of Health and Long Term Care strategy of reducing wait times for certain procedures. This report ,“Health Results Team Third Annual Report 2006-07: A Focus on Results and Sustainability,” shows growing evidence that efforts to increase system capacity using more effective practices are having positive impacts.
However, the questions of value and utilization of innovation in our real-life health care, within busy medical practices remain largely unaddressed in any systematic way. Almost perversely, the more numerous and sophisticated our advances in medical research are, the more of a strain they cause on the health care system, whose job is to deliver these advances to patients.
Perhaps there is way to apply to health care the kinds of managerial systems and operational practices that have been so successfully applied in a variety of other industries.
Take commonsense innovations underlying Toyota’s revolutionary production system, The Toyota Way. Toyota focused its efforts on the principle of clearly separating work from waste. They analyzed each step in the work process, identified what was absolutely necessary to get the work done, and everything else was classified as waste. By eliminating such waste on the production floor, Toyota saw tremendous simplification in the work processes. Productivity, as well as quality, started to rise dramatically.
The system is founded on:
Result? Toyota’s cars have dominated quality rankings for years.
Imagine if doctors had better information on which treatments work best for which patients, and whether the benefits were commensurate with the costs, needless treatment could be junked, the savings could be substantial, and patient care would surely improve… If only there were an agency with the resources and authority to conduct comparative-effectiveness studies, modify regulations, and change current practices.
Here’s hoping that we come closer to discovering this body in 2008.