The group of seven "students" met twice a year with GE "teachers" for structured didactic sessions to learn about marketing, strategic planning, and finance, he says. They worked to define a project and worked on it over two years. Through the process of working on the problem -- in Collins' case, medication reconciliation -- the group defined interventions and followed up with data.
"At first, it seemed a little bit Mickey Mouse," says Collins. "But very helpful was that it reinforced a discipline to approaching projects. People like me never saw an opportunity I didn't like. It's easy to get swept up in enthusiasm for fixing problems, but essential to solving them is refining goals and measuring success."
I usually shy away from long quotes, but Collins gave me perhaps the best, most concise explanation of what has happened with society's implied contract with physicians that I've ever heard, and it shows quite concisely how business training can help physicians understand how they fit into the big picture of healthcare costs and outcomes today:
The bargain we had with society is that physicians acted on the basis of best science or best evidence. Society said, 'you know what's best, so you decide.' That led to very little discussion on risks and benefits with patients because we were presumed to know what's best. Medicine has become distanced from the application of best evidence. As the public has become more aware of that, including government and insurance companies, we have more regulations, which further decreased our autonomy. What that says is that over time, individuals' clinical autonomy became a cause of suboptimal performance relative to clinical science. That led to wide variation, which brought the attention of insurance companies and led to their managerial control with guidelines, protocols and regulations. That's been a source of frustration. Paradoxically, in the pursuit of autonomy, we've lost it, and to reframe that, we have to function in ways that will reduce variation around best practices. Even though I believe medicine is collaborative undertaking, physicians have the responsibility for what goes on. As healthcare has become more complex, that model really doesn't work anymore and physicians aren't good followers. The task is challenging, but we can learn a lot from other industries."