Why is collaboration missing in health care?
An essay posted by Fareeha Kahn, MD (“A hospitalist’s struggle to find teamwork in academic medicine“), raises an important issue. The problem of lack of collaboration is not unique to academic medicine. The problem is the result of misaligned incentives.
Having read the work of Harvard Business School professor Michael E. Porter, I better understand the goals and challenges of value-based care. If we look at the premise of Dr. Kahn, the hospitalist complains about the lack of effective hand-off, and the abandonment of the patient to the outpatient “ether.” Dr. Kahn is scrambling when attempting to schedule an outpatient visit for a soon-to-be discharged hospital patient. There is fewer staff handling more patients in doctors’ offices. That includes the job of scheduling appointments. One essay from my upcoming book refers to the chaos in the emergency room, particularly when an ER physician attempts to transfer a patient to a tertiary hospital for an invasive procedure unavailable in his community hospital. When push comes to shove, success on the 23rd phone call by the ER physician is not a success but rather a sign of the lack of a sense of responsibility for the patient.
