Chaos and Organization in Health Care

by Thomas H. Lee, James J. Mongan MD, Laura Cushing-Kidney (Assistant)

Two leading physicians' prescription for solving our health care organizing the fragmented system that delivers care. One of the most daunting challenges facing the new U.S. administration is health care reform. The size of the system, the number of stakeholders, and ever-rising costs make the problem seem almost intractable. But in Chaos and Organization in Health Care , two leading physicians offer an optimistic prognosis. In their frontline work as providers, Thomas Lee and James Mongan see the inefficiency, the missed opportunities, and the occasional harm that can result from the current system. The root cause of these problems, they argue, is chaos in the delivery of care. If the problem is chaos, the solution is organization, and in this timely and outspoken book, they offer a plan. In many ways, this chaos is caused by something the dramatic progress in medical science—the explosion of medical knowledge and the exponential increase in treatment options. Imposed on a fragmented system of small practices and individual patients with multiple providers, progress results in chaos. Lee and Mongan argue that attacking this chaos is even more important than whether health care is managed by government or controlled by market forces. Some providers are already tightly organized, adapting management principles from business and offering care that is by many measures safer, better, and less costly. Lee and Mongan propose multiple strategies that can be adopted nationwide, including electronic medical records and information systems for sharing knowledge; team-based care, with doctors and other providers working together; and disease management programs to coordinate care for the sickest patients.

278 pages, Hardcover

First published September 21, 2009

Reviews

[Raj Dash · Rating 3 out of 5]

Parts of this book are completely circular in their logic. If you are an outsider you can enjoy this more than folks who have been living this chaos since the 90's. If you want to understand where parts of ACA (Obamacare) arose from, check out the book.

1. Effective Healthcare requires large practices
2. Effective healthcare requires expensive EMR systems (I argue that many lower cost options had been overlooked like the VA which uses Vista..cost 5% of the most popular EMR in Minnesota. Average of $250M for five years)
3. Repeat one and two again and again until you puke.
4. If we want to reduce waste and have effective coordination of care... repeat #1 and #2 some more.

The authors are part of Partners Health (Boston General, Brigham and Women's). Two of the most respected institutions. They are both MD(s) and both quite smart obviously. They just need to have an outline. Omit repitition. use Scientific method to support the premises and it would be golden. I agree with most of the book. It's good to read most of the time. Some good examples from Biesinger, Kaiser and more. Just tedious at times.

[Joel · Rating 4 out of 5]

Good summary of present state and much of the history of how we got here. Central theme is that nothing is wrong that true, integrated, organization of providers could not fix. A bit weak on the recommendations but a great book to start providers (and others) thinking that fragmentation leads to poor quality, high cost, and many errors. Well written.

[Zhifei Ge · Rating 4 out of 5]

keenly summarized that the problem in healthcare delivery lies in differential progress of technology and payment system