As if in follow-up to my previous discussion about the obese healthy care delivery system as well as a follow-up to Escape Fire and the Time Magazine article on health care costs (conventional wisdom says read the article, ignore the conclusions), I was forwarded this link to a story in the Daily Beast about why Cleveland Clinic is the wrong model. In the article, Meg McArdle points out all the good thing that Cleveland Clinic can do, but then points out:
Last spring, I interviewed Charles Bosk, a sociologist who specializes in studying the way that doctors and medical systems handle error. “Atul Gawande answers the wrong question,” he told me. “It’s not whether checklists are effective. Anybody who has made it through third grade, and/or made it through the supermarket with or without a list, knows that checklists work. What you need is to ask is, ‘What would motivate professionals to use checklists?’ ” Checklists invert the normal doctor/nurse hierarchy, giving nurses the authority to, say, step in and stop the procedure of inserting a central line. That’s tough for many doctors to swallow. And hard for nurses to do, unless the culture ensures that they genuinely shouldn’t fear later retaliation.
When I asked Cosgrove [the CEO of the Cleveland Clinic] if other hospitals could really emulate the Cleveland Clinic, he said “yes, other people can do it. One of the things that is beginning to drive this is the patient satisfaction scores that is now becoming part of the pay for hospitals.”
But he also said “both the incentives and the culture matter. They’re inexorably tied. We’ve gone through a very major cultural renaissance if you will to begin to tie everything together.” And he clearly recognizes that on the culture front, the Cleveland Clinic is something special.
In both the Time article and the movie, the Cleveland Clinic is held up as a model. To be successful, the docs at the clinic have suppressed their egos to improve care. Are they really the only health professionals in the US willing to do such? I certainly hope not.