A Vision for Tomorrow: Systemic Alignment
The Problem Previously Known As Noncompliance
The inability to efficiently improve medical compliance, especially at a time when healthcare costs for many industries have become a major cost of doing business, is costly and frustrating. (A recent McKinsey Quarterly observed that, “In a few years, the average Fortune 500 company may be spending as much on health benefits as it earns in profits.”)
Widely misunderstood, medical noncompliance is a problem more ideological than pathological. Its complexity belies our obsessive drive to find a panacea for it. Indeed, Medical Noncompliance is ultimately no more than a label we’ve assigned to an extraordinarily wide and varied category of non-optimal behaviors patients exhibit in response to their clinicians’ treatment recommendations.
Consideration of this predicament, while disheartening, does provide useful insights for future efforts:
- Noncompliance is not a phenomenon limited to the arena of medicine. There is little evidence that compliance with medical instructions is inherently distinct from compliance with laws, advertising campaigns, safety requirements, or recommendations from other professionals. Thus contributions from anthropology, social sciences, and psychology, especially research in decision-making, the diffusion of new ideas, marketing research, game theory, and general systems theory, can be profitably applied to this problem.
- Similarly, although the term Medical Noncompliance implies that the fundamental issues center on the disease, the treatment, and the medical environment, the heart of the problem seems to be an individual, intrapsychic matter rather than a universal effect of the medical condition. To address compliance then, we need to assess compliance-pertinent personality factors at work in an individual patient.
- While most efforts to improve Medical Compliance have focused on the final stages of the medical event (e.g., taking a pill, arriving on time at a rehabilitation appointment, eating foods appropriate to a given diet, etc.), it may well be that the proactive problem-solving needs to occur much earlier, in the course of shaping a treatment plan for a particular patient and in the working relationship between clinician and patient.
- Each discrete behavior encompassed by noncompliance may
- present in an infinite range of severity
- result from any of a multitude of causes
- have an impact on the prescribed treatment that varies from trivial to catastrophic.
However tempting and intellectually appealing the idea of a one-size-fits-all solution may, no single technology or tactic can offer a panacea. Instead, a rational approach to improving medical compliance must take into account the diversity of noncompliant behaviors by utilizing multiple approaches and personalizing these efforts.
- The methodology must be integrated into the local healthcare system, automatically implementing mechanisms to detect and address noncompliance. In the absence of such a methodology, clinicians often overlook noncompliance and its impact on treatment outcomes.
- The time and skills necessary to execute the compliance-enhancement strategy must meet the demands of feasibility. For more than a decade, healthcare professionals have been required to perform more and more clinical tasks in less time. Any plan that obliges the physician to wedge yet another time-consuming procedure into the patient visit is doomed, as is any system that requires nearly psychic capacities for insight or the bedside manner of a Marcus Welby.
- The system must be self-monitoring and self-correcting. In the absence of an evidence-proven methodology, it is essential that the success or failure of any tactic be assessed and the entire system adjusted if that is indicated by the results.