The question was asked; In times of budgetary pressure, what quality initiatives should be sacrificed.
Asking that asks the wrong question. The right one is asking what can be done to better design and operate care critical processes to advance quality, affordability, and access simultaneously.
The first question reflects unwarranted arrogant pessimism, the latter better justified humble optimism.
Here is a fuller explanation.
In a recent e-mail, Jim Womack urges the lean manufacturing community to get beyond Toyota, implying that what can be learned from Toyota has been, in particular tools of shop floor production control.
That is the wrong challenge, in my view. The real challenge is to expand beyond understanding lean as a set of tools, and more aggressively pursuing an understanding of the comprehensive approach to managing organizations so they are capable of self-diagnosis, learning, and relentless internally generated improvement and innovation.
After all, Toyota didn’t displace GM, Ford, and the rest because it out value streamed them. It displaced its rivals because it out discovered them.
Dear Reader,
Thanks for the added note about health care markets and regulation. In a separate note, I’ll pick up the idea of ‘commons.’
SUMMARY: Markets and regulation are not mutually exclusive. Markets exist as a means for customers to allocate scarce resources over competing needs and for suppliers to offer competing alternatives to meet those needs.
The question is: Does regulation foster market health or does regulation replace markets as the means of making resource allocation decisions? There are appropriate applications of both forms of regulation.
Sometimes, regulations promote market health by fostering the flow of necessary information and making choices/contracts/decisions/agreements enforceable. Other times, regulations replace markets because reliable contracts cannot be written or conditions lead to monopolies.
When we look at health care, we see that regulation to foster competition is more appropriate than regulation to replace competition.
Please read below for more elaboration.
Thanks!
Steve Spear
Related Posts:
“Repair Healthcare Markets So Markets Can Repair Healthcare”
“Theory and Evidence for Repairing Health Care Markets So Markets Can Repair Health Care Delivery…”
In response to a recent post, “Repair Healthcare Markets, So Markets Can Repair Healthcare Delivery,” I was asked the ‘theory’ behind such a proposal?
In fact, this is sound theory both because (a) the causal logic is sound and (b) there is evidence supporting the logical statement.
For those opposed to market based competition as the means of transforming quality, affordability, and access of health care delivery, the response question is: what is the soundness of a regulatory (centralized and public versus distributed and private approach to resource allocation? My guess? Quite unsound.
Read more, below, for elaboration.
Thanks!
Bravo to Bob Herbert (”A Less Than Honest Policy,” NY Times, December 29, 2009) for outing this crazy Senate health care proposal. It is exactly as he describes, an elaborate way to tax and spend–to transfer wealth and dependent on setting wage and price controls, both on health care professionals and also on those who need their services.
It will not advance quality, affordability, and access, despite its promises.
The are two real problems in healthcare right now. One is the obvious one for which government is somewhat well suited to tackle. Some people have too few means to meet their own needs. Providing them with assistance is the charitable thing to do. We do that with essentials already: Food, housing, eduction, and some medical. No reason not to get that better.