I was at a conference in June and ran into a doctor from Boston who suggested I read Michael Lewis’s Moneyball, a 2004 nonfiction book about baseball. He thought it would influence the way I think about health care.
Because baseball and health care are exactly the same, right?
I like baseball so, I read it. And it did change the way I think about health care and how we do it at Group Health. To explain, I have to give you a “bullet presentation” of the Moneyball story:
- Baseball is full of things to measure. Most of what people currently measure doesn’t help teams win games;
- The Oakland Athletics (A’s) baseball club has a limited budget to spend on players (compared to other teams);
- The A’s think measuring the right things (that others don’t) will help them win more games than richer teams that can buy star players;
- The A’s are right.
Oakland players focus on key behaviors that link, step by step, to the ultimate goal of winning enough games to make the playoffs. Players practice patience when batting, they wear out pitchers, and they don’t take low-yield risks. Mastering these critical behaviors is difficult for players, who have risen to the highest levels of baseball by doing just the opposite (heroic acts and big risks).
What about this baseball story resembles health care? Lots:
- Health care is full of things to measure. Most of what we currently measure doesn’t help patients to be healthier;
- Health care has a limited budget to spend on making patients healthier (though we haven’t yet learned to live within our means);
- Group Health knows that measuring the right things will help us help patients be healthier, and we’ll do it more affordably than everybody else;
- We’re right. Right?
By developing our Medical Home Model of care and managing it with Lean methods, we link day to day behaviors of primary care teams to the ultimate goal of affordable excellence. We seek out care gaps, develop care plans to manage disease, encourage prevention, and give patients multi-modal access to our whole team. And team members talk—in person—about patients, processes, and outcomes. We’re learning what is effective as we go.
But this is hard work! The skills we are asking one another to master are not what got us here. We have to work against our training, conventional wisdom, and—hardest of all—our habits. I am awed by the size of the challenge and the enthusiasm my colleagues show for taking it on.
Primary Care is unique in its complexity: breadth of scope, information volume, rapid scientific change, and human (patient) variability. There is so much to measure. As in baseball, conventional wisdom encourages health care folks to measure things that don’t matter much. Even our current Medical Home systems follow flawed metrics. We can improve our metrics and our processes by careful observation, respectful questioning, and incessant experimentation. We reinvent the work as we do it, share what we learn, and script—temporarily—the moves we believe critical to achieving affordable excellence.
We are in the infancy of our work with Medical Home and Lean. In 2013 we’ll look back at our 2010 processes and metrics and say: “Why did we measure that? We’re so much better at this now.” And in 2015? We’ll be better still, our work will look different, improvement cycles will be shorter; 2010 will look like the Middle Ages.
Several major league teams have adopted Oakland’s “evidence-based baseball” methods. As we get better, others will adopt ours. This is good news. Health care needs change. And Group Health has to lead it, because we can.






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