ByMoritz M. Ziegler, M.D.
As a retired academic pediatric surgeon and as a member of the Board of Trustees of my alma mater, Capital University, Columbus, Ohio, I am vicariously reliving the challenges of the last 40 years in American healthcare, and particularly in academic medicine and surgery, as our Board charts a vision and its supportive strategies to deal with the evolving “perfect storm” facing higher education.
The first assumption will be a given; namely, higher education is behind healthcare in its reform management strategy in terms of recognizing and responding to those factors effectingchange. What might be debated is how far behind—one decade, two decades?
Though there are differences between changes in healthcare and the challenges confronting higher education, there are also striking similarities both in the opportunities and obstacles and their putative solutions. An important example of the similarities is the value proposition. That is;
In medicine does the cost expended appropriately relate to the diagnostic and treatment outcomes desired by the patient and the care team that would include the third party payer?
In higher education does the value proposition align cost of education with an assurance of career success: a completed education, a degree, and an appropriately desired job opportunity?
Another example is quality.
Quality, patient safety, and measured treatment outcomes are inherently linked in medicine. Similarly, the quality of higher education might be expected to be linked to a predictable “comparative effectiveness” characterized by a student receiving specific proficiencies, a fund of general and specific knowledge tied to career choice, and a passion for life-long learning.
Reforms in healthcare were largely a result of effective change engineered throughout the 20th century. In addition, they served as the by-products of multiple evolving phenomena:
- Provider-centered care was replaced by patient-centered care;
- Individual experience, impression, and prejudicial thought processes were replaced by evidenced-based medicine;
- Quality and safety outcome measures that were first promulgated and then rejected more than 100 years ago were eventually replaced with renewed real-time, risk-adjusted, quality measures;
- A culture of blame and shame was replaced by transparent non-punitive efforts to improve outcomes; and,
- A culture that had assessed and assigned fault to individuals was replaced by a recognition of the role which systems failures play ineffectingadverse medical outcomes.
- Access to medical care and its increasing costs are hurdles made increasingly difficult by an industry where continued innovation, research, and development have remained a priority.
Also, to make matters even more complicated, third party payers have begun using quality scorecards to recognize and reward positive physician and hospital behaviors while dis-incentivizing poor quality outcomes.