At the Helm

How U.S. health system execs should look at the rest of the world


There’s no shortage of research studies and news articles talking about how inefficient and ineffective the U.S. health care system is. One case in point: earlier this year, the Commonwealth Fund released the latest edition of its report assessing health care performance in the world’s wealthiest countries—and the U.S. ranked dead last.

But these comparative rankings don’t tell the whole story, and they’re not really the right way for American health system executives to look at their efforts, achievements, and opportunities.

For the past several years, I’ve been spending a good portion of my time consulting with health care systems outside of the United States, including some that are listed in the Commonwealth Fund report as well as health systems in less-developed nations. Those experiences have revealed to me a few important things American health system executives ought to understand about their position relative to the rest of the world, things I almost never see written about or discussed.

1. U.S. leaders are in an unsurpassed position to make meaningful impact

Despite the downbeat headlines on comparative health system effectiveness, I firmly believe that American health care executives are in one of the best places in the world to innovate on health care delivery and improve the quality and efficiency of health care.

Compared to most other countries, the U.S. offers significantly more flexibility to health care providers to apply novel care delivery models that the providers determine are best suited for their patient population. Moreover, America’s recent innovations in payment models and health care delivery, such as accountable care organizations, bundled payments, and value-based payment incentives, are actually at the forefront of worldwide innovation. I’ve seen leaders in many other countries looking at the U.S. experience in population health management and health system reform with great interest.

2. Health care delivery in the U.S. has plenty to be proud of

Although it still has the highest per-capita health care costs in the world, the U.S. can justifiably be proud of its ongoing care delivery transformation. But that’s not the only area where American health care providers are excelling. 

Based on my work with international health care leaders, another area where the U.S. seems to be at the forefront of the international health community is in patient safety improvements. In recent years, a number of American health care organizations have been actively implementing system-wide safety structures, to an extent that health systems in most other countries have yet to match. For instance, Ascension Health’s safety initiative has reduced serious safety events by 80% across the health system.

Lessons from Anthony Tersigni, CEO of Ascension Health Alliance

In addition, outside of the United States, health care performance data often remains unavailable to the public and practitioners alike, and I’ve seen the lack of health care outcomes data hamper attempts to improve safety and quality internationally—even in countries ranked higher than the U.S. in the Commonwealth Fund report.

The value of recognizing these successes is not simply to say, “Congratulations on your progress,” but to underscore that within the U.S., we have tools, resources, and examples to help continue improving outcomes, lowering cost, and elevating the patient experience.

3. Non-U.S. innovations could offer solutions to American health system challenges

Still, there are many areas in which the U.S. health care system can improve relative to the benchmarks set by the rest of the world, and individual health system leaders will need to drive many of the needed improvements.

What’s more, fixing some of the issues of the American health systems may not require new-to-the-world strategies. It could be that another country, even one you necessarily wouldn’t think of first as a model—has found a successful solution.

Take the question of how to deliver primary care more efficiently, for instance. I was recently visiting with health care officials in Bangladesh, where they are exploring a promising concept for using trained, non-medical personnel to navigate the health system and provide certain types of support.

The support includes diagnosing and managing simple acute illnesses and even some chronic illnesses. In the areas where Bangladesh has applied this concept, there has already been an improvement in managing sickness.

Another area where other countries are significantly ahead of the U.S. in health care delivery model innovation is standardized, predictable, low-cost approaches to providing surgical procedures. Health care researchers have been talking about the benefits of “focused factory” approaches to surgery for decades, but few U.S. health care providers have managed to bring the concept to life the way I’ve seen in other countries, such as India.

In the coming years, I’m hopeful that the American health system will continue to make progress in the areas where the trend has been positive, like population health management and patient safety. Likewise, I’m convinced that we can learn more from innovations across the globe if U.S. health care leaders look outside our borders, not with discouragement but with a realistic appraisal for where we’re strong ourselves and what we can learn from others.

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