Transformation is the key to creating value in health care, which—in turn—can produce better outcomes for patients and reduce burnout for physicians.
This was the message of Elizabeth Teisberg, PhD, who gave a presentation at the AMA’s Chicago headquarters on high-value, relationship-centered care.
To look at the transformation that is needed, just consider what has happened to telephones, said Teisberg, a professor at the Dell Medical School and McCombs School of Business and executive director of the Value Institute for Health & Care—all at the University of Texas in Austin.
Phones were only used for making and receiving calls and were tethered to the wall, but are now used to take pictures and pay for airline tickets. Without transformative thinking, telephone innovation may have ended with the addition of longer cords.
In seeking to improve patient experience, health care has focused on things such as cutting waiting-room times and providing hotel-type amenities. These may represent positive changes, but are only the tip of the iceberg.
Concentrating on outcomes that matter to patients will improve their quality of life while lowering health care costs because living in good health is less expensive than living in poor health, Teisberg said. It will also lower the rate of physician burnout by boosting professionalism and focusing clinical attention on meaningful results rather than processes dictated by third parties.
Exposure to system inspires research
As a systems engineer studying strategy and innovation, Teisberg said she didn’t intend to work in health care but “then life happened.”
“I had a deep dive that you don’t want into the health care system,” she said. This included taking care of two children with complicated health needs and providing end-of-life care for their grandfather.
The experiences opened her eyes to an environment where an overwhelming number of smart, hard-working and caring people are working in a system with unwarranted variation, disparate care outcomes, high costs and sluggish innovation.
“It doesn’t make any sense. That is the puzzle that drew me in,” she said.
After her two kids got well, Teisberg dug into the problem. This resulted in co-writing with Harvard School of Business Professor Michael Porter the influential report, “Redefining Competition in Health Care,” which was published in the Harvard Business Review.
“Our research shows that competition in the health care system occurs at the wrong level, over the wrong things, in the wrong geographic markets, and at the wrong time,” the report says. “There is no villain here. Poor public-policy choices have contributed to the problem, but so have the bad choices made by health plans, hospitals, and the employers who buy their services.”
She was not the corresponding author, but Teisberg still received 38,000 emails following the report’s publication—mostly from physicians. Teisberg and Porter then wrote "Redefining Health Care: Creating Value-Based Competition on Results," a foundational work on value-based care delivery and health care strategy. The fundamental insight she offered is that the goal needs to be better outcomes for the money spent, not just cost reduction. There needs to be less focus on cost shifting, building market share, or “turning the wheels of the current system faster.”
How to get started
Getting started on this journey can seem overwhelming. But Teisberg recommends a simple first step.
“Measure something,” she said. “Pick something you recognize as meaningful and measure it.”
Too often, however, health care has picked the wrong things to measure. Instead of asking if the bedsheets were comfortable, patients should be asked about their lives outside of the health system, Teisberg said.
That means asking about pain, function, quality of life, or what’s it like to be the parent of an asthma patient?
Teisberg said outcome measures that matter to patients generally fall into these three buckets:
- Capability: Can you do the things that allow you to be you?
- Comfort: Did you get relief from pain, anxiety or depression?
- Calm: Does your care induce chaos or enable calm?
When physicians transform their work to focus on these outcomes, they report that their “practice has never been more rewarding,” Teisberg said in an interview.
Technology can help—if used the right way.
“Use technology—particularly communication technology—in ways that tighten a relationship and not replace it,” she said. “Also, the information you’re exchanging should be something you can respond to and be clinically useful and actionable—not something you ignore.”