In December 2016, the PwC Health Research Institute Report characterized 2017 as a year of uncertainty and opportunity for healthcare.
In many ways, that prediction held true. There was tremendous uncertainty around the Affordable Care Act in the US, not to mention uneasiness about value based procurement, mergers and acquisitions, payment changes and antibiotic resistant bacteria.
Contrastingly, there were also strides made to adapt, innovate and build for value (also predicted in the PwC report), focus on quality and push the boundaries of science and technology in the delivery of care.
As 2018 quickly approaches, healthcare remains an industry poised for even more change, prompting the question: what is next for healthcare? Is this the start of a new era?
The concept of eras in healthcare is most familiar in the context of Donald Berwick’s work, “Era 3 for Medicine and Health Care.” In it, Berwick breaks healthcare down into three eras – effectively past, present and (what he hopes is) the future.
Era 1 traces back to the beginning of medicine as a profession, stretching back to the days of Hippocrates. At the start, medicine was a noble, elite profession. Practitioners were infallible. Broadly speaking, it was an idealistic era. However, as Era 1 crept closer to modern day, research into the profession revealed that healthcare, like all industries, had its flaws and challenges.
This emergence of doubt and questioning marked the start of Era 2, characterized by heightened scrutiny, pressure for accountability and the high stakes of rewards and punishments. According to Berwick, the juxtaposition between the romanticism of Era 1 and the scrutiny of Era 2 fueled discomfort and has left healthcare professionals feeling alienated and over-controlled.
According to Berwick, the clash between these two eras has left healthcare primed for new change. His hope is for Era 3, a period characterized by “transparency, improvement science, less inspection and more civility.”
Berwick prescribes 9 changes that he believes are essential to ushering in Era 3:
- Reduce Mandatory Measurement
- Stop Complex Individual Incentives
- Shift the Business Strategy from Revenue to Quality
- Give Up Professional Prerogative When It Hurts the Whole
- Use Improvement Science
- Ensure Transparency
- Protect Civility
- Hear the Voices of the People Served
- Reject Greed
As for the best place to start, he recommends #7. That recommendation has been echoed by Derek Feeley, IHI President and CEO who wrote, “A lack of civility exacerbates the stress and demands of already stressful and demanding professions.”
“If health care is characterized by civility, then we’ll have a workforce that’s much easier to engage in improvement. We’ll have people more engaged in the organization’s priorities and activities. And we’ll have more productive relationships with patients and families.”
The pressure healthcare professionals experience is often alarming – more than half of US physicians experience burnout and dissatisfaction. Beginning the Era 3 journey is not unrelated to the values of the Quadruple Aim, which focuses on improving the work life of providers and staff.
Era 3, says Berwick, is a chance to usher in a moral, trusting approach to healthcare. To worry less about revenue and more about quality. To incentivize safe, quality healthcare as a unified pursuit. And to honor, respect and empower patients as true partners.