Constant conflict between two schools of thought in modern medicine "roils the healthcare landscape," and it is time to usher in a new era, according to Donald Berwick, MD, former CMS administrator.
In an Op-Ed for JAMA, Dr. Berwick said the root cause of much of the conflict in healthcare comes from dissonant beliefs that stem from two different eras in medicine.
The first era of medicine he describes is the "Golden Era," of sorts. Era 1 is characterized by the belief that medicine is an inherently good, noble profession that should be self-regulated, according to Dr. Berwick. These ideas were upended when researchers found large amounts of variation, error and waste in the healthcare system, he wrote.
So on came the second era, of which we are currently in the midst. This era is characterized not by professional trust and autonomy, but by accountability, scrutiny, measurement, incentives and markets. It is about incentives and punishments, he wrote.
The discord between the two eras "impedes the pursuit of the social goals of fundamentally better care, better health and lower cost," Dr. Berwick wrote. "…When the ethos of professionalism clashes with the ethos of markets and accountability, immense resources get diverted from the crucial and difficult enterprise of re-creating care."
Thus, he writes, it is time for a third era, one that is characterized by continual design and redesign of healthcare. The beliefs of the first two eras should be rejected in this third era to make way for a number of changes, which Dr. Berwick lists in his viewpoint. Among these changes are reducing mandatory measurement to only what matters, putting an end to incentive programs for individual physicians and shifting focus away from revenue to quality.
More articles on leadership and management:
Glenn Medical Center, EmCare form partnership: 5 things to know
Is NEJM's reputation slipping? 5 things to know
Regional Medical Center to cut 33 positions: 5 things to know