While the iSixSigma.com site has been down, the rhetoric about “fixing healthcare” in the US has dramatically heated up. “We need to take the waste out of healthcare!” “We’re paying too much for healthcare!””Everyone should get all the healthcare they need regardless of cost!”

Without getting into the political debate, let’s just touch on these points from a quality perspective.

There’s a balance between cost, speed and quality that’s quite a challenge in healthcare. For example, if I order $5000 worth of tests on day 1, and can tell you your diagnosis on day 2 and start treatment, what’s that worth to you and your health (even if it turns out that 5 tests out of the 30 ordered didn’t help with the diagnosis)? How about taking the cost-effective route: I’ll order one test per day, evaluate the results, and then order the next test. It may take me 21 days to figure it out, while you are waiting all the while, but hey! it did cost less! So, in which example was there more waste???

Paying too much for healthcare…does that mean we are paying more than the value we receive, or just more thanwe desire to (or can afford to) pay?Most of us a) don’t know how much our healthcare actually costs; b) can’t judge the quality of the medical care we receive; and c)won’thaggle over the cost ofan IV solution when thecare of a loved one is at stake.There’s an emotional element of this debate that is not susceptible to logical reasoning. We see this in all the stories of people who have gotten poor care or ran out of money or their insurance wouldn’t cover a certain procedure. If we try to “ration” care in the most logical way possible, we immediately run into the emotional (or moral, if you prefer) discussion about denying care to those who need it on a purely financial basis. The factual and emotional issues are entangled as we debate this topic.

Should everyone get the healthcare they need regardless of cost? It’s my personal opinion that provision of basic services, including healthcare, should bea function of an organized society. But, it’s not a “commodity” service like garbage collection, is it? Since we do have to look to our tax-paying citizens and employers to pay for “healthcare for all” – the question of course is, how much should each of us contribute to this worthy cause? And who decides how that money is to be used?

Having stirred the pot this morning, I will close by saying – it’s a complex system!

• There are no “specifications” for inputs (patients who need care come in all conditions and with variation in their genetic, mental, physical, experiential, cultural, economic, and social backgrounds);
• Processes are highly complex with many stakeholders and overlapping responsibilities
• There is anexpert-based culture ofphysician caregivers(now expanding slightly to other medical professionals);
• Outcomes may not meet the patients’ goals through no-one’s fault (you can mostly blame our biologically-based life processes, I guess) but which may in some cases be due to poor care or non-compliance on the part of the patient (for example, not taking medications in the way they were prescribed).

So I just caution you to think carefully about all the proposals that will be floated to “fix” the healthcare system, and don’t jump to solutions too soon on this one.

Is healthcare in its current form in the US perfect? NO! But first I think we have to go back to quality basics and agree on who are the customers, and what is value-added to those customers. I’ve seen many more “solutions” floated, than thoughtful consideration of just what it is we want to get to. I encourage everyone to join this debate from the quality improvement perspective, and to lend your expertise to the discussion!

p.s. It’s good to be “back on the air” again! Kudos to those at iSixSigma.com who have been working to resolve the issues that interrupted service over the past several weeks.