Raising Standards in American Health Care: Best People, Best Practices, Best Results

I entered consulting in 1978 after a dozen years working in corporate America. What I experienced was nothing less than culture shock as I encountered an approach to management that was woefully behind the revolution that was then occurring in business and industry. Driven by merciless competition from Japan and Europe, American management had forsaken disproved management concepts and was retooling their industries. This was the era of the Chrysler rescue and the Harley Davidson resurgence. Business was learning the painful lesson that unless you change how you manage, you had better update your resume. That learning paid off as American business took strong center stage in the 1990s as an evolved management system produced magnificent results.

Where was health care during that era? As a presenter I couldn't talk about “profit” or “customer” in the early 1980s without having audiences react in shock. Health care as an industry was in a time warp, notably behind the advance of the management profession and seemingly oblivious to its direction. Much has greatly changed, and health care management has moved a long way past the stagnation caused by the old cost-reimbursement model that held up normal industry evolution. At this moment, we're still catching up to the state of the management art—gaining rapidly but not yet there.

Americans love the direction health care is moving—new technology, new services, new solutions. What they hate is a cost picture caused by system inefficiencies that bankrupts recipients and payers. These inefficiencies result either from services performed at too low a level (a standards problem) or by using approaches that have not been standardized on best practices. On the quality front, health care has become the scandal of the week in the media.

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