As Congress continues to hash out what will likely be more or less bad health care reform legislation, it is worth considering what health care providers themselves can do to fix the system.

One outstanding case study is The Nun and the Bureaucrat: How They Found an Unlikely Cure for America’s Sick Hospitals. The book is a compilation of quotations, factoids, and anecdotes from employees and administrators of two hospital systems, Catholic SSM Health Care in St. Louis and Pittsburgh’s Regional Health Care Initiative. It tells the story of the implementation of “systems thinking” at these institutions. In short, the health systems’ executives perceived serious inefficiencies and dysfunctions in their hospitals (with, sometimes, life or death consequences) and determined to borrow a method successfully used in other business enterprises and apply it to the medical field.

Individual hospital outcomes reported include:
–85 percent reduction in hospital acquired infections (often fatal and each entailing costs of $30,000-90,000).
–medication error rate reduction from .16 per thousand dosages to .01 per thousand.
–reduction of acute diabetic complications from 13.5 percent to 5 percent.

Besides better patient outcomes and cost-saving, hospital staff reported higher levels of morale and satisfaction in their work.

In this particular case, conscientious and innovative CEOs initiated change. What might drive innovation and improvement more broadly in the health care sector is placing both control and responsibility squarely in the hands of “consumers” (patients), spurring competition and setting up the right framework of incentives. Any legislation that fails to recognize this connection will fail to move us toward a health care system that more effectively serves its intended purpose.