“Hospitals, they want to do your robotic surgeries, your heart catheterizations, your PET scans, your MRIs — all the expensive items,” says William Biggs, chief executive officer and medical director of the Amarillo Legacy Medical [accountable care organization] ACO in Texas. “We actually felt that hospitals were part of the problem.” … Biggs recalls recently boasting to a hospital executive about reducing admissions [to hospitals] by 15% in 12 months. Biggs says the man responded, “Well, don’t do it all at once.” Paying Doctors To Shun Hospitals, Bloomberg Businessweek, Feb 17, 2014.

Sometimes, we first have to change the system to see how things will really work. While I’m not a great supporter of top down directed programs (business or Federal), I do like it when I see these kind of unanticipated improvements happening from an improvement initiative. It means to me that we’ve probably made some fundamental changes, for the good.

The article mentions how the assumption was that the big hospitals would probably lead these new Accountable Care Organizations (ACO) but it turns out it is doctors forming them and often leaving out hospitals.

We might initially think that all they are doing by leaving out the hospitals is reducing costs and hence they must be reducing care to increase profits. We think this because we all know that hospitals (and the medical system itself) is only about scientifically based and expert chosen best care tailored to the individual …. OK, probably not. They are also businesses.

They are business systems, human designed and operated systems, and hence they have all the faults and imperfections of any such system. We hold our medical system in high esteem in part, I always felt, because we didn’t understand health and because we were culturally encouraged to do whatever the doctor told us to do, without question.

I tell the story of an older woman who was complaining about all the pills she had to take each day and how it was easy to get it wrong. I asked her, someone naively, why she was taking them. In retrospect that was a fairly personal question to ask and I shouldn’t have asked it. However, her answer startled me.

She looked at me with a “boy, are you stupid” look and said “Because my DOCTOR told me to!” Because a doctor had told her, it must be right and the only thing to do. She didn’t question it, because a doctor told her so.

I now notice that more often we hear guidance to “partner with our doctor” and “take charge of our own health care decisions.” I read of one doctor who said that in the past they always advised people to see a doctor before starting on any exercise program. Now he tells people to just get up and move as the risk of too much exercise are overshadowed by the risk of continuing to do nothing. I also admit to laughing when for awhile one commercial on TV, selling something like Cialis or Viagra, advised us during the required listing of the numerous side effects to also check with our doctor to see if we are healthy enough for … sex. I wondered if I could just text my doctor for permission when needed?

So I find there are two key lessons from this experience with the ACOs in the Affordable Care Act. The first is we often have to just try and see what happens. I like smaller scale pilot projects over monolithic one size fits all approaches, but still a try is a try.

The second is that many things we are just so sure of, often aren’t the greatest once we have alternatives. By changing we provide a different environment, hopefully one that encourages new ideas and innovation. Then we get to see what else is possible rather than just repeating what we’ve done in the past because we think that it is the only way.

What changes could you make to your project approach that might encourage new and more effective ways to getting projects completed on time and with good quality?