Book Review: Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery by James Champy and Harry Greenspun, MD.
Jim Champy has become well known within the business world for his books and leadership in business transformation. His first book with the late Michael Hammer, Reengineering the Corporation: A Manifesto for Business Revolution, released in 1993, sold three million copies. He has since written seven additional books including Reengineering Management.
Reengineering Health Care, which he wrote with Harry Greenspun, MD starts out with the simple question as the title of chapter one: Why Reengineer Health Care? In this chapter, they point out that while health care has kept pace with science and technology for diagnosis and treatment, it has not kept pace in its delivery. They state that computers aren’t the problem, but rather the application of technology and how work is organized around it.
While I read this book, it rekindled some memories of Champy’s first book with Hammer. I went back and reread my highlighting and margin notes from that first book. The prevailing and consistent theme was the focus on the components of the "three-legged stool": People, Process and Technology.
In fact, there are chapters in Reengineering Health Care dedicated to each of these components. In each of these chapters, they offer case studies in which they exemplify real people who have combined the three legs to improve health care for better results from a financial, patient care or procedural perspective. Lessons learned are provided with detailed explanations for each, explaining the why and the how. For instance, in the chapter on technology, one of the tips is to protect physician productivity. They go on to explain that one of biggest concerns physicians have with IT systems is a poorly defined system that distracts them from patient interaction, slowing their productivity. They described a real-world case in which they involved physicians, nurses and other clinical staff in the design of the process around the technology, which gave them both buy-in on the process, and an efficient system designed around how they need to get their jobs done.
There are two additional chapters that each showcase a successful reengineer that they have encountered in their research and the path they’ve followed to improve healthcare and some of their long-term results.
As with Champy’s first reengineering book, a chapter is included titled "The Hunt for Reengineering Opportunities". This provides a primer on how to get started and some tips on how to identify the "burning platform" or the greatest pain-point as a place to begin. Do you start by focusing on better quality delivery of health care? Improved financial results? Improving the process to make the physician and staff more efficient? Each medical facility must decide for itself.
There was an opportunity for Champy and Greenspun to make this a dry, process laden tome as a how-to on process improvement methodologies within the health care industry. To their credit, they’ve created a very readable, yet informational book that provides excellent examples of leadership and descriptions of methodology that both informs and motivates health care providers to take the plunge into their own internal health care reform. Can one read this book and know everything there is to know about reengineering health care within their own medical facility? Certainly not; and that’s not the intent of this book. It does provide an excellent overview of the benefits that can be gained and some high-level lessons learned on the considerations to be made in such an endeavor. A medical facility that is seriously considering a reengineering project should probably partner with an experienced consulting organization with the appropriate experience to help them implement it correctly.
Health care reform is one of the hottest topics in the news. Government incentives – and eventual penalties - are driving many health care organizations to implement electronic medical records systems to gain compliance with government mandates. Reengineering Health Care comments that the result of recent legislation was essentially health insurance reform. Stating that "up to 40 percent of the insurers’ operating costs is spent on administrative processes...some hospitals write off up to 30 percent of what they bill because of the complexity of approval and collection procedures", Champy and Greenspun make an excellent point that a reengineering effort is worth implementing for the benefit it provides regardless of government incentives and penalties. The time is right for those in the medical industry commit their organizations to the provision of better health care, improved efficiency and better financial results. Reengineering Health Care is the first step that a health care organization should take to making that commitment.