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Excessive Incentives and Rules – Where Did the Wisdom Go in HealthCare?

Posted Feb 19 2009 5:29pm

If you have not seen this video, it is well worth watching.  He touches on something I have said most of my life, “There’s more important things in life than having to be right all the time, but do the right thing”.   I probably have a few readers here that know me that have heard this over the years and might chuckle that it has finally made it to the blog! image

Barry Schwartz makes an excellent exhibit of the “hospital janitor” and how the “human” side of his job description is completely not existent. It’s the human side of the job that is left out in the job description.    There’s one real good message for all of us here.

We have too many rules and it is creating a downward spiral of sorts and we also have excessive incentives, especially in medicine.  It makes you stop and think, is this profitable or is it right?   As an example, risk management is only interested in profitability, thus we end up working with payers that are only perhaps looking at one side of the coin, is is profitable, and the part about whether or not it is right is buried. Doctors fight this all the time, just ask one. 

We use the rules, or other wise called “ALGORITHMS” created in computer code to determine our decision making processes, and the process of whether or not it is right or wrong can get lost in the translation.  SO WHAT CAN WE DO TO BRING BACK THE WISDOM?   Listen to the video and I think there are some real good points made here and ideas to ponder and think about.  

It has a lot to say about what is wrong with healthcare today.  

Philanthropists and Venture Capitalists   throw their arms up in frustration as they too are dealing with a world of rules and excessive incentives that are pivoting progress in the wrong directions, especially relating to research and development efforts to cure disease. 

Having written formulas myself, I might be a little bit closer to the issue than others, but I have not lost the “human” side either and it’s something to really think about as it creeps up on you before you know what happened and unknowingly one is caught up in the world of rules and incentives only, forgetting about questioning their own internal wisdom, and if you don’t tap into that resource at least once in a while, it can be forgotten, and narcissism and lack of human wisdom predominate.   BD

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In the latest release from TED2009, psychologist Barry Schwartz makes a passionate call for “practical wisdom” as an antidote to a society gone mad with bureaucracy. He argues powerfully that rules often fail us, incentives often backfire, and practical, everyday wisdom will help rebuild our world.

TED Blog: The real crisis? We stopped being wise. Barry Schwartz on TED.com

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