Macro-applications of the Requisite Organization theory in the healthcare system

Speaker A When you did this study, a lot of the early work at Brunel in the BIOS group was with the UK hospital system, health system. And I wondered, did you look at any how requisite have been used in their health or did you look at the UK system or any of its experience there?

Speaker B I did from the standpoint of understanding how it was going to be, what was going to be, the coordination of care and the availability of care, and what the analysis and review of it was in the UK system and was it effective? Did it get primary care out there? Were there groups of people that have been for some reason had denying care? There are all these stories of people waiting four years to get vasectomies and things like that that isn't effective. So we wanted to get the lessons learned from that before we walked into something that would mean it was a very totally closed system. I don't know if you particularly pulled it.

Speaker C No. But I remember when we went to Australia, subsequent to that, they'd asked about the intervention. But there's fundamental differences when you have a capitated healthcare system where you've given so much money to treat a local population versus workload. And we had abandoned workload a decade ago.

Speaker B Before that, well, I mean, we were in the transition of doing that was one of the things. We said that it was not going to be a workload based system, that there were only so many dollars and we were going to figure out what the smartest way was to use those dollars. And we knew Art, that in fact, one of the responsibilities of the higher level planners was to somehow project what the load demand was going to be of the particular population in those demographics. What could you expect a year, two years from now? In kinds of cases?

Speaker C I guess what Steve's saying is that as we look at the healthcare challenge of America today, it's really if ever there was a level seven challenge, it's taking on the healthcare system because you're not going to be able to do it with a single system, a single fix. You're going to have to do it with some combination of public health and a number of different things. And yet we see the proposals seem to be at too low level in terms of our capability to address the system. We're a microcosm of the country, but we're a closed system. And so we've got lessons learned that would be interesting. If you really are serious about taking on the system in the Australian case, until they were willing to take on workload, there's no way that you're going to control costs because people are going to generate workload because that's how they get reimbursed. And so you'll have a children's hospital built right next to another children's hospital because there's no reason why one would want to. And the regions, when we set the regions up. The regions were critical because you looked at what was there in the Savannah community and you said, well, I'm not going to duplicate that in my medical facility because I can't afford to do it. The infrastructure has already been spent.

Speaker B Well, I'll give you a lesson learned from what I'm doing now, because right now I'm the director for Child and adolescent Services in a private psychiatric hospital. We have innumerable patients who are hospitalized, not because and rehospitalized two and three and four times a year because there is an absence of good outpatient services in the community. So we had those lessons, we knew that in the 15 years ago now. And we said, the responsibility for a clinic commander, department head, hospital commander is to look at the whole span of services and how you're going to allocate providers and think about not only think about it from a standpoint. Of what's in the patient's best interest, particularly keeping them out of the hospital and keeping them well, but understanding that if particular services are available, and they're available at the front lines, then that will minimize what will be the more expensive and more serious consequences of an illness.

Speaker C We had to change the hours of certain clinics. Children get sick, I'm sorry, they get sick at night and weekends, they don't get sick during the day. Or mother's working and she comes home. And so we had to change the hours. We had to put a minor acute care shut off the emergency room. I look at an emergency room in the Savannah Hospital America today, you need to get rid of the people that don't have critical care requirements. They're not going to not come, they're there. And so you need to organize your delivery. And so again, it was easier because it was a closed system where we could make those kinds of I mean, I remember the humorous thing we wanted to build more ors well, wait a minute, let's run a three shift operation. They don't want to come to work at six. Tough. Give them an order. In the army, you can order them to come to work. I said to you, Steve, give them an order. Because people said we don't start surgery at 06:00 A.m.. Well you do now. And so there are some certain things you could do. You, this is.