Make no little plans. They have no magic to stir men's blood and probably themselves will not be realized.
-Chicago architect and city planner Daniel Burnham
IIf it were not for unrealistic, impractical people such as Burnham, Chicago might still be a collection of wooden hovels in a lakeside swamp. At the moment, healthcare could use a few people like him.
While the long-awaited second Institute of Medicine report on revamping the nation's healthcare industry got polite applause last week (March 5, p. 4), the sounds of impending resistance were deafening. Between the praise and recitations of quality initiatives already undertaken, providers and insurers slipped in murmurs of trouble. The document is too vague in its recommendations for the next 10 years and too sweeping, some said. Physicians will resist standardized clinical practices as "cookbook medicine," others asserted. American Hospital Association President Richard Davidson spoke of the need for "caution" and "realistic timetables." And, almost everyone asked, where are we supposed to get the money?
With all deference to the pragmatists among us, a little wide-eyed reform wouldn't be so bad in an industry plagued by bad quality. The IOM report is scathing in its criticism, noting that although American medical research leads the world, it takes 17 years for new knowledge to be put into practice. "What is perhaps most disturbing is the absence of real progress toward restructuring healthcare systems to address both quality and cost concerns, or toward applying advances in information technology to improve administrative and clinical processes," the report's authors wrote.
"Despite the efforts of many talented leaders and dedicated professionals, the last quarter of the 20th century might best be described as the `era of Brownian motion in healthcare,' " they said. "Mergers, acquisitions and affiliations have been commonplace within the health plan, hospital and physician practice sectors....Yet all this organizational turmoil has resulted in little change in the way healthcare is delivered."
If healthcare leaders choose to stall and pick the IOM document to death, they should remember this: History lauds dreamers and reformers, not self-interested defenders of the status quo.