“It is a well-known axiom that what is not measured can’t be managed.” So claimed Robert Kaplan and Michael Porter in the opening of their 2011 Harvard Business Review article “How to solve the cost crisis in health care”. Well-known, but well analyzed? Did Kaplan and Porter measure the accuracy of their axion?
Their article provides a list of seven steps “to estimate the total costs of treating…patient populations”:
1. Select the medical condition [specifying the possible “complications and comorbidities”]
2. Define the care delivery value chain…which charts the principal activities
3. Develop process maps for each activity
4. Obtain time estimates for each process
5. Estimate the cost of supplying patient care resources
6. Estimate the capacity of each resource and calculate the capacity cost rate
7. Calculate the total cost of patient care
Don’t look for:
8. Calculate the costs of doing all this.
But you can get a sense of it by reading the authors’ example of a knee replacement, for which 77 activities are listed.[ 1] Multiply this by hips and elbows, hearts and heads, update it with each change in procedure, and you have to wonder if analysts will soon outnumber clinicians in health care.
But the direct costs are not the only costs. How about the costs of distracting the clinicians―for example, by having to record so much data―plus that of the political battles that ensue over who is measuring what, how, where, when, and for whom. Analysts see measurements as objective; contrast this with the political blood spilled over determining them.
Imagine if analysts put themselves through the same scrutiny as some do everyone else: i.e., imagine if they analyzed themselves. Maybe then, instead, we would get more of the following:
Years ago, the British retailer Marks and Spencer decided it was spending too much money controlling the movement of stock in its stores. So instead of a clerk filling out an order form to replenish a shelf, which was handed to another clerk behind a counter, who went to fetch the items, so that the first clerk could sign off on another form and take the items to the shelf, the company got rid of the whole procedure and simply let the clerks go in the back and scoop up what they needed. The company was able to function with thousands fewer clerks and 26 million fewer cards and papers.
Now that’s truly efficient, also a vote of faith in the integrity of clerks. Managers of professionals take note: treated with respect, left to figure out things for themselves, professionals can prove to be as trustworthy as clerks.
Do we need really experts who know better? It’s been said that there are two kinds of people: those who believe there are two kinds of people and those who don’t. I don’t know about that, but I do believe there are two kinds of experts: those who really do know better and those who, by believing they know better, do worse.
Surgeons, as experts, certainly now better. We, their patients, don’t say: “Will you cut a little lower please.” They have a technical expertise that we don’t question. But how about teachers, architects, and managers who know better? By standing above those they serve, they can get in the way of their own success. Include many analysts here too, including those who analyze the work of surgeons. Maybe such experts need to listen better.