Video Transcript: Providing Better Care for Less

Neel Shah, MD; Assistant Professor, Harvard Medical School

Well, there's a window of opportunity right now to do this. Right now in the C-suite of most big, complicated delivery systems — or honestly even smaller practices, where I know lot of the IHI membership is working — there is this top-down directive from policy-makers and payers and others to be accountable for both the quality and the cost of services. We know that.

We also know there's mounting bottom-up pressure from our patients. More Americans are in high-deductible plans than ever before. An average deductible if you get a silver plan on any health insurance exchange in the country is $3,000 to $5,000. That's like real money no matter who you are or what kind of income you have. It's not money you want to blow, for sure.

So, clinicians in the front line are feeling this, and people that are at the health system leadership level, they, I think, often and set the culture. I think culture is often set in a top down way. You now have an aligned interest around this.

So I think if you're leading a health system, in 2013 your health system was probably like a revenue center. That's how you ran it. You thought about it as a revenue center, like, "I need to get more patients in it so we can make more money." But now it's being managed more like a cost center, like, the way to protect our margins is to figure out where the waste is and get rid of it.

The people that know where the waste is are the people that are running the show for real. The truth is you can walk onto any ward of any hospital in the United States and ask anybody there — the unit clerk, the nurses, the residents, anybody — "What are five things that we do every day that are wasteful, that don't need to happen?" And they could give you 10. So, lots of opportunity there.