Health IT, Hospitals, Policy

What healthcare should NOT learn from Amazon

Ed Park Presentation at HIMSS from Brian Ahier A few months ago I spoke with […]

A few months ago I spoke with the CEO who ran several nursing homes. We were having lunch in Cincinnati and I mentioned a recent health conference that featured an executive from Disney.

“I am so tired of hearing about how healthcare should be more like Walt Disney World,” he said. “People don’t want to come to my nursing homes. People don’t want to go to the hospital, usually. You can’t say they’re the same thing because they’re not.”

I’ve never liked this comparison either. The emotional component of healthcare — the fact that happy and sad do not come in equal portions — is only one reason that healthcare is not like Disney. Healthcare can be a transaction, but it’s also a longer-term process and a relationship. You can’t get a dose of healthcare like you can get a dose of Disney through a week-long trip. It’s also not possible to rigorously control every aspect of a healthcare experience as Disney is able to do with a visit to its parks.

This conversation came back to me when I read “What healthcare can learn from Amazon” by athenahealth COO Ed Park. His article is about more general tech best practices, while his HIMSS talk focused on open and closed IT systems. His slides are at the top of this post.

People were ooh-ing and ahh-ing over this comparison and he does have some good points. I can’t argue with efficiency and good design and brilliant use of data. But healthcare is way more complicated than smart selling and good logistics. It’s messy and emotional and fulfillment is much more than just delivering a treatment or even an experience.

Here are three elements of Amazon’s equation for success that healthcare providers and companies should not adopt.

Buying things we don’t need, aka overutilization
We’ve all been on Amazon to purchase something that we only need to buy once. Or even something that we didn’t end up buying in the first place. I unsubscribe to most Amazon emails because I don’t want to be tempted to buy, buy, buy all the time and to avoid the constant: “You bought this, so you MUST want this too!”

We are already spending too much money on healthcare that we don’t need and that doesn’t make us healthier.
Choosing Wisely has 34 lists of procedures that patients should question when a doctor suggests them. A big part of the push behind EHRs is to cut down on duplicate tests. Parents shouldn’t always come away from a pediatrician visit with antibiotics. There is no magical pill (yet) to make you healthier and stronger and often people are resistant to cheaper but more challenging lifestyle changes. Often it’s easier to “try one more thing” at the end of a person’s life than to have a conversation about death.

The answer to fixing healthcare is not always, “Give the patient exactly what she wants” — unless it’s her data that she is demanding, of course.

Relying only on metrics
Yes, we need best practices to be more widely used and yes, data is important. But making performance data the most important factor in the equation is not going to fix healthcare. It reminds me a lot of the debate around standardized testing: Do we want kids who can take tests or kids who can think? Do we want doctors and nurses and pharmacists who know how to complete a checklist or do we want them to have the knowledge and authority to customize or even disregard that checklist based on their own expertise? Patient surveys are important certainly, but I don’t want the standard of care based on whether or not a nurse was having a bad day or how well the TV remote worked.
People are not machines – neither the ones giving care or the ones receiving it – so we can’t give metrics all the power in determining how healthcare is delivered or how it is evaluated.

Treating front-line workers like disposable robots
There is a reason Amazon can charge lower prices than everyone else, and part of that reason is the way they treat their workers at the warehouses that make the Bezos empire possible.
Who are the corollaries in the healthcare world? Home healthcare workers:

The Bureau of Labor Statistics expects that registered nurses, nursing assistants, personal care aides and home health aides will have the largest employment increases, adding 1.6 million jobs now through 2022. RNs will grow 19.4 percent (526,800 jobs) but the BLS projects home health aide jobs will increase 48.5 percent (424,000 jobs).

These workers have to deal with all the emotion and mess of basic healthcare needs, but they are poorly paid. At the same time, new research suggests that these workers can help reduce readmissions, by up to 40 percent. As hospital systems get bigger and bigger, nurses are going on strike to protest poor treatment of nurses that lead to compromises in patient care.

Fixing healthcare (and preserving a hospital’s bottom line) should not come at the expense of nurses and other caregivers who do not have MD in their titles. Healthcare executives should not copy Amazon’s approach to employee management.

I could not agree more with Park’s call for change in healthcare: “We must embrace change at a time when it has never been clearer that the old way of doing things will no longer work.” Not only does the IT infrastructure need to be replaced and rewired, the culture of healthcare has to change around decision-making, ownership of data, and professional turf. Patients need to step up as well to improve their health literacy and understand their own choices.

But we need to be smart enough to find solutions that make sense for healthcare and all its complex patients and business challenges that have nothing to do with creating a wonderful customer experience when buying stuff online.

Veronica Combs

Veronica is an independent journalist and communications strategist. For more than 10 years, she has covered health and healthcare with a focus on innovation and patient engagement. Most recently she managed strategic partnerships and communications for AIR Louisville, a digital health project focused on asthma. The team recruited 7 employer partners, enrolled 1,100 participants and collected more than 250,000 data points about rescue inhaler use. Veronica has worked for startups for almost 20 years doing everything from launching blogs, newsletters and patient communities to recruiting speakers, moderating panel conversations and developing new products. You can reach her on Twitter @vmcombs.

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