"Scalability" at the point of health delivery

While health systems in the U.S. strive for operating economics through scalability, the concept of “scale” is often reserved to corporate services and operating infrastructures, it is rarely a concept applied to the “point of service”. The question is “does scalability apply to caring for patients one at a time?”  

Opinions differ. One health economist views health care providers as a “trade guild”. They do what they do, how they do it, based upon how they were taught to do it by those who learned from those who came before them.

Not an altogether bad model for the professions, but this approach may explain why known best clinical practices take upwards of ___ years to find their way into accepted, common practice .

Interprofessional team care is often professed as a means of achieving improving scale in clinical care (producing an equally beneficial unit of service at a measurably reduced rate of production cost).

Clinicians apply interprofessional teams variously to patient care. In a study conducted by colleagues and myself physician specialists did a better job of leveraging their time with the use of licensed extenders (improving the productivity of their available time) while primary care physicians who worked alongside extenders were, for the most, doing the same jobs as the extenders (an 88% overlap in clinical output of physician and non-physician providers).

At least three questions are of consequence here:
  • if total costs of care are to be managed to lower levels, with outcomes held to the highest standards, how much non-justifiable variation in clinical approach is tolerable;
  • who in healthcare organizations will have the principal responsibilities for pursuing “scale” at the points of health services manufacturing; and
  • what skills/competencies are required that are not resident with health systems today; e.g. rapid acquisition and deployment of efficacious health services delivery innovations (home-grown or those derivative of others’ work)?

Daniel Zismer, Ph.D.2013