Reengineering American health care — Steve Spear

MIT Sloan Senior Lecturer
Steve Spear

Our community was wrestling with the exorbitant and still rising cost of educating our students.  Technology, salary and other expenses are factors of course, but those generally grow in line with the economy overall.  The big problem is the cost of medical coverage for faculty and staff, growing faster than other revenues or expenses, thereby crowding out other important needs.

In this regard, health care is an extreme outlier. With everything else – cars, computers, entertainment, transportation– we assume that availability and quality will go up while unit costs keep going down, and goods and services become more plentiful. But not with health care.  Appropriately enough for someone who works at MIT, an answer can be found by considering this nation’s health care system as a system engineering problem.

One reason why health care is so grossly expensive, inefficient, and often risky in terms of avoidable error is that providers often operate independently, even though efficiency and quality require integration of individual professions into a well-choreographed whole.  I remember shadowing surgical residents who were examining a patient.  They left, and then cardiology residents rounded, followed by the psych team addressing dementia issues.  You would have thought they were talking about three separate patients inhabiting the same bed and not one patient with three ailments.

In contrast, engineers got past this “sole practitioner” hubris long ago.  I remember driving by an historic aircraft on which my uncle worked.  He commented, “That was the best project ever!!!”  Why?  Because his expertise as an electrical engineer found its fullest expression imbedded in this huge, creativity straining, cross-disciplinary, collaborative project that was far grander than anything he and his colleagues could ever manage on their own.

To solve our healthcare delivery problems, we shouldn’t do away with medical specialties or individual physician discretion.  MIT, after all, depends on departments to build deep expertise within disciplines.  But at MIT, expertise also gets developed and expressed in laboratories and centers where people tackle problems by bringing in needed resources, no matter from what department.  Healthcare needs to adapt this engineers approach—both in training and in practice, at junior and at advanced levels.  Certainly, build the skills specialists need to be valuable contributors, but build and practice those skills along with the skills of collaborative problem solving and treatment.  Then when patients go for diagnosis and treatment, they can encounter systems of care which are measured by overall outcomes and treatment effectiveness, rather than the piece meal approach we have now.

This is about more than just saving money. It’s about maintaining public trust. Because health care consumes a huge portion of the commonwealth, it has an obligation to figure out how to deliver more value while using fewer resources. And to achieve that, the health care system must reengineer itself.

Steven Spear is a Senior Lecturer at the MIT Sloan School of Management and at the Engineering Systems Division at MIT, author of The High Velocity Edge, and a Senior Fellow at the Institute for Healthcare Improvement. He has published in medical journals such as Annals of Internal Medicine and Academic Medicine

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