Friday, November 16, 2012

Medical Innovation – Let the Market, Not the Politicians Decide
The market economy as such does not respect political frontiers. Its field is the world.
Ludwig Edler von Mises (1881-1973), Human Action
Market competition is the only form of organization which can afford a large measure of freedom to the individual.
Frank Hydeman Wright (1885-1974), Freedom and Reform
November 16, 2012-  When I started Medinnovation blog  in November 2006, medical innovation was very much on my mind.  I had just finished a book Innovation-Driven Care: 34 Concepts for Transformation (Jones and Bartlett, 2007). I was hot on the subject of clinical innovation.
But cataclymic events intruded – the deep economic recession 2008,  Obamacare passage in 2010, collapse of social welfare programs in Europe. 

In the course of writing 2550 blogs to date,  my attention has shifted to profound transformations in medical practices,  government interventions into clinical freedoms,  electronic information technology revolution,   role of physician and American culture on these monumental events, and how physicians are adjusting to what’s transpiring out there, much of it beyond their control.
Out of these chaotic happenings has emerged the idea of organizing my daily blogs into a series of little books with the omnibus and immodest title of New Voice of Health Reform: Rhyme, Rhetoric, and Reality (Medinnovation Press).  
  • Rhyme  because there often seems no rhyme or reason for what’s happening and events are so harsh and complex they do not lend themselves to straightforward prose.  
  • Rhetoric because the political and management talk is often so abstract and lofty that it  deosn't truly indicate what’s taking place on the ground.
  • Reality because someone needs to bring these complex and sometimes chaotic events into a sharper focus to which we can all relate.
It isn’t easy to separate the wheat (the realities) from the chaff (the rhetoric) in the complex adaptive world of medical and healthcare affecting every American. Ideologic posturing  confuses everything.  The fact that Obamacare was strung out over ten years with nothing much happening from 2010 to 2014 in order to sell it for less than $1 trillion when its true cost from 2014 to 2024 was $2.6 trillion complicated matters.
In describing what’s happening,  I have found it useful to apply these principles (borrowed from Edgeware: Insights from Complexity Science for Health Care Leaders (VHA, Inc, 1998).
  1. Recognize reforming health care is complex and doesn’t lend itself to sweeping innovation by centralized government or fragmented markets.
  2. Do not try to spell out in detail what needs to be done because no one is smart enough to know.
  3. Acknowledge that outcome data has a place but must be balanced against intuitions, needs, and motivations of patients and physicians.
  4. Go to the edge of clinical events to see what works and is affordable.
  5. Deal realistically with the paradoxes and tensions of change which will never please all of the people all of the time.
  6.  Know that multiple actions must be tried to see what direction to take before one proceeds with some grandiose scheme.
  7. Listen to gossip, rumors, conversations, and dissent before taking subsequent actions.
  8. Look for simple systems that work independently before incorporating them into an integrated complex system.
  9. Mix cooperation with competition, realizing that independent entrepreneurs are going to strike out on their own.
In any event, out of this thought process has emerged a series of little books on health reform. One is done, and others are in production.
These include:
  1. Physicians, Poetry, and Humor -  Health    reform, being a human thing dependent on human foibles and behavior, is much too serious to be taken seriously all of the time.
  2.  The Physicians Foundation ,  New Voice of Medicine -Through its national surveys, white papers, and research grants,  this organizatihn has shown a bright light on what’s really happening out there to physicians.
  3. The Physician Culture and the American Culture- Their Affect on Health Reform.
  4.  Primary Care and Specialty Care – Their Roles and Evolution in Health Reform.
  5. Medical and Health Care Innovation. Parallel but Not the Same.
  6. The Information Revolution and Medical Records – and the Patient-Physician Relationship.
Tweet:  Health reform calls for a complex adaptive system and requires both govenment and  market responses with an emphasis of human freedoms.

To purchase Physicians, Poetry, and Humor, click on  this  link and enter your credit card information.

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