3. A Better Goal for Health Care
To get better results from any process, it is necessary to clarify the purpose of the process: what results it should be designed to deliver. You might be surprised to hear that there isn’t a standard, agreed-upon answer to the question, “What is the purpose of health care?”
If you ask a doctor, you might hear: “To diagnose and treat disease.”230
Public policy experts might say: “To improve population health,” which means using the available money to get the best health outcomes for the greatest number of people for the longest period of time. For instance, spending money to clean up the water supply and create better sewage treatment systems was and continues to be one of the best ways to improve population health.
You might conclude that the actual purpose of the health care system today is "to deliver tests and treatments." The health care system certainly does that. For example, each year there are 130 million trips to emergency rooms, 101 million hospital outpatient visits, and 37 million hospital admissions.231
Consider backing up a step to ask who the primary beneficiaries (or customers) of health care are. You might answer, “the people who need/receive care.”232
Then consider a second fundamental process design question: what do they want from the process of health care? Most people don’t want to be patients; having a medical problem that requires dealing with the health care system is a huge and unwelcome disruption. What they want is to get back to their normal lives.
Putting together those two answers, one could conclude that health care’s purpose should be to enable people to lead the lives they want.
Of course, health care can’t solve every medical problem, and other resources are needed for people to lead the lives they want. That said, many people might conclude that it is not good enough for health care to act as if its purpose is simply to deliver tests and treatments.
Consider what Dr. Don Berwick, a proponent of individual-centric health care, had to say: “I have come to believe that we—patients, families, clinicians, and the health care system as a whole—would all be far better off if we professionals recalibrated our work such that we behaved with patients and families not as hosts in the care system, but as guests in their lives.”233