Donald Berwick, now director of the Centers for Medicare and Medicaid Services (CMS), has written often at the Institute for Healthcare Improvement about patients being the center of health care.
His new job puts him in charge of doing something bigger, however, which is building one health care system for aging and poor patients.
But how do you build a system around so many different parts and motives?
Fact is, the United States has among the most diverse collection of hospitals in the world, facilities with many different agendas, and patients are not always at the center:
- Corporations like HCA, which are motivated by profit and must get it from hospital services.
- Religious groups, Baptist and Catholic, Jewish and Methodist hospitals, for whom service is part of the ministry.
- Non-sectarian non-profits, most of which serve a specific city or region.
- Public hospitals, for whom patients are the mission but mainly less well-off patients.
- Charity hospitals, similar to public hospitals but without a government guarantee backing them.
- Doctor-owned hospitals, similar to the corporate group but focused on the needs of those doctors who own the facility.
- Integrated hospitals, like InterMountain and the Kaiser system, which sell coverage and thus have a motivation to control costs.
- University hospitals, which are mainly focused on research.
Take my own hometown of Atlanta.
Some hospitals here serve multiple masters. Grady Hospital in Atlanta was a public hospital but is now a private charitable group, tasked with training doctors and running a trauma center as well as serving the poor.
The largest hospital system is Piedmont, a non-sectarian non-profit. That's also the status of the largest children's hospital, Childrens Healthcare of Atlanta, which 12 years ago merged the University-led Egleston Hospital with Scottish Rite, a masonic hospital whose first facility was a half-mile from my house.
Many hospitals own remote clinics. Some hospitals are chains.
When hospitals change owners they can change missions. The former Georgia Baptist Hospital in Atlanta is now Tenet Atlanta Medical Center, its faith-based mission replaced by a profit-minded one.
These missions can be incompatible. Emory Healthcare, which is at heart a research hospital, this week ended a partnership with HCA, each taking ownership of a different facility. "There were two different ways of doing business," an observer told the Atlanta Journal-Constitution.
That's the point. There are many different ways of doing business in the American hospital industry, many different agendas that can be followed. It's not one system, but many -- religious, corporate, regional, local, research, public.
Where do patients fit in? Different patient groups fit differently into each niche in a different way. Sometimes they are sources of profit, sometimes they are interesting cases, sometimes they are poor lives in need of saving.
Setting one course for such a disparate industry will be a massive undertaking.
This post was originally published on Smartplanet.com