Resources Reconsidered

December 20, 2018

Academic medical centers and the universities that house them have become big businesses. To take two examples: Duke and Stanford University (together with their associated health systems) are relatively modest in size by today’s standards for nonprofit healthcare systems. Still, both reported annual revenues of in excess of $5 billion in 2016. And for both institutions, the largest share of expenses on the balance sheet comes from salaries and benefits for employees and faculty.

In other words, when we talk about the healthcare industry, we are in essence talking about people. 

Over the course of a career in which I’ve become increasingly involved with healthcare and research administration, I’ve noticed the ubiquitous habit of referring to people as “resources.” The Oxford English Dictionary defines “resources” in this context as: “A stock or supply of money, materials, staff, and other assets that can be drawn on by a person or organization in order to function effectively.” For the narrow purposes of financial aggregation, lumping personnel costs with inanimate equipment makes sense. But inanimate resources and people are very different. When a manager or leader reduces the number of copy machines or consolidates purchasing for more efficient use of technology, such a decision seldom triggers strong feelings, and money saved can be redirected to laudable purposes. However, when an organization “downsizes” or “right-sizes” a workforce in order to adapt to change, there are direct human consequences.

When we talk about the healthcare industry, we are in essence talking about people. 

I’m hardly the first to make this point, and the internet is full of blogs, posts, articles, and tweets on this topic. Even the management divisions of corporate America have been undergoing evolution on this score, as awareness of the consequences of depersonalizing language permeates the larger culture. However, using terminology that collapses the categories of “human beings” and “inanimate objects” seems particularly problematic in healthcare, which is based on the understanding that every person deserves specific consideration of their circumstances, including the key relationships that affect their health and well-being. 

Maintaining humanism in the healthcare sector is about to be put to the test by two enormous forces now affecting the entire industry. The first of these is the inevitable healthcare reform measures that must occur when a rapidly growing healthcare sector consumes ever larger shares of the US budget (and accounts for an ever-larger share of US GDP and workforce) while delivering inferior results relative to those achieved by peer nations – a point that my friend Eric Topol has been raising for some time.

The second is the incorporation of automation and artificial intelligence, a development that’s already bringing profound changes to the entire healthcare workplace. In another blog entry, I’ll discuss why I believe that many of these changes will ultimately result in more people doing more meaningful work. However, at a minimum it seems clear that our current approach, which has given rise to a massive secondary apparatus to support coding and documentation for billing, must change. Greater efficiency will mean fewer people working on such functions, but if we get AI and automation right, the result will be more room for the human touch in healthcare, and many of the people currently doing “paperwork” could be usefully employed in directly delivering care to people. Just visit a nursing home or an extended living facility, and you will see the enormous need for human services.

My hope is that as we learn to deal with an accelerating pace of change in healthcare, we will be able to find new ways to integrate the human component into all that we do. Still, people will be directly affected by these changes, and the path forward will not always be simple or easy. But an essential first step, in my view, is to remain clear on the distinction between people and inanimate resources.

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