China as the U.S.'s Teacher

By: Gloria Lee

Before the Obama legislation called out its new recent health care system, more than 25 million American people did not have health insurance at all. To make things worse, previous health care systems were also ineffective. “Reengineering must be done, and it must be done by clinicians,”1 claimed Jim Champy, the author of Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery in 2010. In a micro-perspective, he contended that the old health care system should be reformed through revolutionary changes in the health delivery processes by enhancing quality and lowering costs, while increasing patient accessibility to the medical system. Nevertheless, he has not free of weaknesses because of macro perspective on health care system: role of government. Thus, in order to reduce costs and improve efficiency, the government must redesign solutions that synthesize patients.

The author emphasizes the necessity of employing new technology to enhance efficiency. “Have advances in science and technology enabled word to be performed in new, more effective ways?”2 Jim Champy begins with a story of Zeev Neuwirth, a medical student at the University of Pennsylvania, who focuses on communication between physicians and patients. Through research and seminars within the medical community, he found out that lack of genuine communication was the central issue. More importantly, he contends that the current system is broken to be totally repaired and persuade by participants of medical procedure. Working at the Emergency Room, Neuwirth concludes that the genuine communication between the doctors and patients is the first step to amend cost and efficiency.

In reengineering, there is a focus on investigating technical workflows and the process of change itself, which means pulling out the project management charts, time studies, and flow diagrams. In his research, he discovered that the process of serving patients had broken down, due to poor relationships between the internal medical staff. Having approached the problem without a preconceived notion of how to solve it, Neuwirth quickly saw that people were the key. He thus developed a way to improve their communication and relationships, thereby improving process performance dramatically. Through he emphasized communication, he also talked about the philosophical idea of the social contract, “the community takes precedence over the individual, and the new social contract goes on to inspire lasting behavioral change.”3 Thus, the author emphasizes new creation of efficient system, not just solving one minor problem.

In addition to finding genuine communication issues, the author introduces the importance of health information technology for a cost effective health care system. Through the example of Scharmaine Lawson-Baker who applies information technology of the non-profit Healthcare Information and Management Systems Society to improve ineffective health care system. Lawson-Baker contends that the current health care system can be improved “when it comes to reengineering health care delivery, however, it’s vital to remember that technology is only an enabler.”4 Once it is improved, Multi Care’s patients are able to access their electronic medical record through their own website, examining the medical results of imaging studies, reviewing immunization history, and scheduling appointments with doctors. Therefore using current medical information technology, current inefficiency and high cost health care system, according to Jim Champy, can be cured.

Consequently, the new technology allows the health care system to prepare for a new era, reestablish guiding principles, involve clinicians in design and implementation, identify champions, adopt formal project-management methodologies, and protect physician productivity. Medical information technology solves the problem of creating national health care-record repository yet providers require solutions nowadays. Thus, in order to eliminate unnecessary costs and increased efficiency, current health care systems should employ electronic healthcare-record systems despite burdens of largest efforts that hospital and engaging health care providers ever has had.

In order to reinvent the health care system in a more efficiently and less costly way, radical versions of terminology and relationship is urgent. Champy delineates that traditional interactions between patients and physicians have not changed even though technological improvement occur regularly. “Medicine has changed, but the exam room isn’t so different from what is was in the 1800s.”5 Successful changes have happened in medical principles recently establishing small experimental test results, going for quick results, preparing for long adoption times, and fixing errors. However, he warns of other harmful changes, such as iterative process change, patient education, chronic customer treatments, continuous management, and the physician’s time control. Therefore, to redesign health care system, new approaches are required to transform away from older versions and mechanisms of medicare procedure.

One contribution that Jim Champy makes in his book is a perspective shift to the patient’s point of view. To reform health care, he specifically emphasizes the necessity of better delivery care at lower costs for patients. In that way, patient’s accessibility can be extended. Furthermore, he claims that the focus of reengineering efforts lies in the needs of patients and families. He delineates successful examples of primary care systems like Atrius Health in Boston, MultiCare in Washington, and employer health care delivery systems at Activate Healthcare in Indianapolis. He details success stories of those facilities in which electronic health records, shared medical appointments, passionate physicians delving in innovative process designs, motivational data, and improved health workforce are effectively adopted, leading to the reinvention of old health care systems. Therefore, he concludes that it is important to apply synthetic yet pragmatic approaches of new systems to reduce long-term cost and inefficiency.

In order to understand his health care reengineering system, it is important to evaluate the author of the book. Born in 1942, James A. Champy is an American business consultant and an organizational theorist of business process reengineering and organizational change. He obtained both Bachelor’s and Master’s of Science in Civil Engineering at Massachusetts Institute of Technology and Juris Doctor degree from Boston College. His approach focuses on four distinct fields: business strategy, business management and corporate operations, organizational development and transformation, and information technology. With many books published including, Reengineering the Corporation: Manifesto for Business Revolution, Reengineering Management, and X-Engineering the Corporation,

James Champy was the Chairman and Chief Executive Officer of Computer Sciences Corporation. He was responsible for providing direction and guidance to the company’s business and management consultants. With his degrees in Civil Engineering and extensive experience, he suggested a reformation of the health care system. He provided the key processes required for the successful reengineering of health care organizations involved in health care. He is currently a Senior Research Fellow at Harvard University’s Advanced Leadership Initiative.

When James Champy first states to a team of health care physicians that their works needed to be extremely redesigned, he was told that the radical was reserved only for the most serious of medical procedures. However, now, he strongly believes only the radical redesign of health care’s administrative processes will provide people lower costs. A “health care system” is non-communication parts, and implicitly dangerous in design. During an average four days that patient stays in hospital, a patient gets to see 24 different doctors and administrators when a physician places an order for medications in a hospital, there are many steps between when that order is given and medication administration for the patient all opportunities for error. Also, this complexity occurs within a health care delivery organization. When multiple doctors, clinics, hospitals and insurance companies are involved with patients, the complexity can be overwhelming due to number of the steps, for both patients and clinicians. Technology, processes, and people are required to reform a real system of care. Information technology will be a big leap: connecting multiple caregivers, giving a portable health record system, and providing the information required to connect treatments to results. However, information technology alone is not be able to deliver cheaper and safer care. Clinical processes has to also change. They sees great advances in treatment of illness, yet many of the processes in care system did not change in fifty years. In addition, the common questions from many patients get asked, real patient education is left up to the patients and the Internet. When information technology is introduced into the hospital’s examining room with no other process change, the physicians’ work becomes more difficult. When work changes better, it is because the behaviors of not patients and doctors changed.

Jim Champy has seen many positive cases of reformed delivery processes. Many examples of health care system are simple. One ambitious example is Novant Health’s Safe Med program. The faculty at Novant, a main medical center in North Carolina, has acknowledged that 18 percent of emergency room circumstances included discharged elderly patients with Adverse Drug Events. These elderly patients were not purposely discharged; they wanted to get home - where they took risk of taking old and new medication. Hence, Novant introduced a program that clinic pharmacists call elderly patients a few days after they are discharged and ask the patients to reassess the medications. The Adverse Drug Events examples appearing in emergency rooms have been reduced from 18 percent to four percent. However, the program required a new technological role for pharmacists, who now must have knowledge of developing computer systems that keep doctors apprised of what happens. Safe Med is a group example of how people, process, and technology can work together to improve safety at a lower price since an emergency room is expensive.

The case for radically redesigning health care delivery can be established by lowering costs and improving safety. Yet, many also believe that different medical practices will soon be in danger of financial collapse if no action is taken. Federally enacted “health care reform” means that through the patients will pay less hospital and clinicians are also paid less for their work because the governmental intervention comes in among patients, hospitals, and the insurance company. Ken Accardi, who reviewed Champy’s book in May 25, 2010, stated that people probably believe that hospitals and insurance companies will now earn more because neither of the hospitals nor insurance companies needs to provide free care to uninsured individuals. However, without radical change, the cost of care rises endless, which burdens the patient’s. With these increased costs and Medicare Medicaid payments being reduced to help pay for “health care reform”, Jim Champy does not know the head of a single hospital who does not fear read ink ahead. Most hospitals already operate on the edge of profitability. It is time for health care professionals to take on the task of redesigning of their work. According to Ken Accaradi in “Book Review: Reengineering Health”, after reading his book, the he clearly recognize that Jim Champy knows and conveys about reengineering systems. Furthermore, health care system in 2010, which were non-governmental intervention, is actually delivered poorly and Jim Champy certainly made claim “how to improve the the quality and efficiency.”6

Today, with health care becoming even more expensive, the United States is in a serious health care crisis; the United States needs efficient innovation to make the health care more affordable and accessible. As Jim Champy frequently mentioned in his book, the America needs dramatic changes in people, process, and technology. However, in addition to the development of communication between the patients and doctors and technology, national government health reform is also needed. Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery informs very specific serious health care system to people.

In 2010, the passage of the Patient Protection and Affordable Care Act (ACA) dramatically altered the United States health care industry and it remains one of the most controversial pieces of legislation passed in decades. The Patient Protection and Affordable Care Act which is also known as Obamacare, works through leveraging opportunities to innovate the health care industry that United States will move closer to the one goal almost everyone agrees upon: making health care more affordable and accessible to all people. Both in Reengineeirng Health Care by Jim Champy and the Affordable Care Act mentions the advantages of healthcare and insurance. First, “the disruptive innovation includes the individual mandate, which requires all Americans to maintain health insurance.”7 The great difference that the Affordable Care Act will bring is that a large population of currently uninsured individuals will be part of the primary care system. The government anticipates that this will increase demand on burdened systems and create space for new care delivery models. Second, “the employer mandate which requires all employer with 50 or more full time-equivalent employees to offer health insurance benefits, increases the financial demands on employers to provide health care coverage for their employees.”8 As employers try to manage expanding health care costs, there will be greater options for different models of health insurance. Mentioned in the book, as technology develops, as the governmental health care system expand and the essential health benefits created by the Affordable Care Act limit disruptive innovation by placing requirements on the services that must be covered by any health insurance plan.

The Patient Protection and Affordable Care Act has immense impact on social, political and economic issues of digital technology on America since the 1990s. People, regardless of their age and property, are able to have insurance. Especially, Online marketplaces allow individuals and small companies to choose health insurance alternatives. Even though the online marketplace will advance transparency in terms of coverage options and pricing, the Affordable Care Act’s strict constraint around coverage requirements essentially puts a floor on the low end of coverage, the limiting opportunities for entrants to provide different types of coverage and method of care delivery. The cost-sharing requirement imposed by the Affordable Care Act—even though created with the noble purpose of making great quality health insurance affordable to low income people—actually sometimes discourages innovation in ways similar to the “Essential Health Benefits and Insurance Exchange provisions.” By filtering low-income consumers into “Silver-level plans” via government subsidies, this arrangement will reinforce the status quo plan designs and artificially constrain demand at the low end of the market.

In Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery, Jim Champy mentions that designing a real system of care requires a combination of technology, process, and people. The extreme and radical improvement of health care delivery processes to enhance quality and dramatically lower costs will greatly expand patient accessibility to the improved care. Very similar to Jim Champy’s ideas, Patient Protection and Affordable Care Act have expanded. Great opportunities now exist to provide care to the millions of patients now entering the primary care system with better communication, and technology. Began in 2014, coverage for the newly eligible adult was fully funded by the federal government for years. Improvements were made in the quality of care and the manner in which that care is delivered while reducing costs at the same time.

[1] Champy, Jim. Reengineering Health Care. Upper Saddle River: Pearson Education, 2010.19
[2] Champy, Jim. 17
[3] Champy, Jim. 57
[4] Champy, Jim. 62
[5] Champy, Jim. 98
[6] Accari, Ken. “Book Review: Reengineering Health Care”: A Good Prime, May 2010
[7] Boudreau, Karen. “A Starter Kit For Better Health Care Delivery”. Health Affairs, April 2011
[8] Champy, Jim 118
[9] Karen M. Boudreau. “A Starter Kit for Better Health Care Delivery”. Health Affairs Web April 01, 2011
[10] Ken Accardi. “Book Review: Reengineering Health Care: A Good Primer”. Ankota: Ushering in the Next Generation of Homecare Blog Web May 25, 2010