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A Business Student Walks into a Health Care Conference...

By IHI Open School | Friday, December 21, 2012

It's interesting to write about "the unique perspective of a business student at a health care conference," when I've spent the last 18 months bringing a health care perspective to business school.


As business students, we're taught to turn financial statements and models into investment decisions. As health care providers, we turn clinical evidence and buildings into care delivery. Both of these tasks are complex, but can be eased by the skill of translation. The business transaction begs the question, "What information does a shareholder need to improve her portfolio?" A clinician can improve care by asking, "How does a patient experience their care delivery?"


The summer before college, I was required to read Lost in Translation: A Life in a New Language by Eva Hoffman (totally different story than the movie starring Bill Murray). The book is about Eva's struggles with communication as she moved from Krakow to Vancouver to Texas to Harvard. At each step, she felt "othered" by the people around her.


When I arrived at school in the fall, I discussed the book with my professor and observed that the syntax was odd and the vocabulary often impenetrable. She asked if I found it hard to understand. I said, "Yes."

She replied, "That's exactly the point."


Attending the IHI National Forum after 18 months immersed in the financial implications of every quantifiable decision was a lot like reading Lost in Translation again. There were a number of sessions I wouldn't have understood without business school: the case studies that used queuing theory to align patient flow or the actuarial cost models for CMMI Innovation awards.


Because of my training in business, though, there were even more things that I couldn't understand: Why didn't we hear about the financial gain of end-of-life follow-up care that helps families and nurses? Why was the business case for reducing c diff calculated after the pilot, instead of doing a prospective break-even analysis? Why are the FTEs for a patient navigator pilot based on a manager's best guess instead of analyzing the resources incurred for each patient activity?


After a rather unscientific survey of fellow MBAs at the Forum (thank you, my n=5), however, I started to see two common values: delivering high-quality service and also financial viability. In school, we've learned this as the Double Bottom Line. It's doing well and doing good at the same time. The term Double Bottom Line also helps translate the conflict between business and health care. The challenge in business is that we often don't talk about the ultimate outcome of our activities — such as the impact on patients when hiring more temporary nurses. Conversely, providers often talk about putting the patient first, but the unspoken assumption is that we don't care about any other outcome. With a Double Bottom Line, performance is measured by financial profit or loss, but it's also measured in terms of positive social impact.


The rest of the Forum showed me balancing measures for both bottom lines. I saw examples of dashboards, panels of action (inputs) and result (outputs) metrics, and qualitative ways to understand businesses, employees, and patients. Leaders were able to translate internal efforts such as acupuncture for homeless patients into external affects for both bottom lines such as lower readmmission rates.


Ultimately, while a business school perspective helped some things make more sense — and some things seem totally foreign — I realized moving forward we're all going to need to be adept at translation.


"The more words I have, the more distinct, precise, my perceptions become. And such lucidity is a form of joy." -Eva Hoffman


Monica VanBuskirk
MBA Candidate
Duke University, The Fuqua School of Business

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