
What if you could see the future? When will homecare providers break through to policymakers about the critical value of care at home? Even more critically, when will homecare providers and visionary academics collaborate to make hospitalization a rare event? While the ability to predict the future is not an exact science, Harvard scientist Francis Aguilar took a step in that direction in his 1967 book, “Scanning the Business Environment.” He developed a process that evaluated political, economic, social and technological trends—the PEST analysis. Researchers have since added two components—the environment and legal issues—to change the acronym to PESTEL. The process is not perfect, but much like modern hurricane forecasting, it can predict a cone of possibility, and that cone offers organizations a significant advantage in a changing world. Today’s health care reform, in the words of another Harvard professor, Clayton Christensen, is a time of “disruptive innovation.”
Change Drivers
Uncontrolled costs, poor quality outcomes, failures in patient safety and the social inequities in access to care are driving today’s aggressive pace of health systems change. Health care costs are $3 trillion per year—nearly 20% of the U.S. gross domestic product. An increase in personal bankruptcies related to health care expenses and runaway profits in the pharmaceutical and insurance industries all point to a need for some kind of disruption to the current model. Many say the United States has the best health care in the world, but the World Health Organization and monitors of global health care dispute that claim. A 2018 Commonwealth Fund report ranked the U.S. last among the world’s top 11 industrialized nations in outcomes, efficacy, care process, equity and value. Patient safety has been a growing area of concern for more than 20 years. Amid evidence that our volume-driven payment model has resulted in overtreatment, the U.S. has the added insult of harm—and even death—caused by system failings. A recent documentary film called “To Err is Human” cites human error in hospitals as the third leading cause of death in the United States; human error results in 440,000 deaths a year, behind only heart disease and cancer. Some troubling statistics:- One-third of all hospitalizations result in a medical error.
- There are 1.7 million hospital-acquired infections per year.
- From 2010 to 2014, surgeons operated on the wrong body part 2,314 times, left tools in patients 4,857 times and operated on the wrong patient on 27 occasions.