10 ways to detect health-care lies

In the past several months, we have observed blatant signs of deceptive, misleading, unsubstantiated and foolish statements in the health-care industry. These include fraudulently marketed products from Theranos“multiple examples of unsafe and incorrect treatment recommendations” from IBM Watson and a recent statement by the CEO of One Medical that his firm aims to take out 10 percent of U.S. health-care spending — something no one has ever done (not even the federal government).

Lies of the health care industry

Why does this kind of behavior occur? While flat-out dishonesty for short-term financial gains is an obvious answer, a more common explanation is the need to say something positive when there is nothing positive to say.

This problem is acute in health care. Suppose you are faced with the assignment of solving the ageless dilemma of reducing costs while simultaneously raising quality of care. You could respond with a message of failure or a discussion of inevitable tradeoffs.

But you could also pick an idea with some internal plausibility and political appeal, fashion some careful but conditional language and announce the launch of your program. Of course, you will add that it will take a number of years before success appears, but you and your experts will argue for the idea in concept, with the details to be worked out later.

At minimum, unqualified acceptance of such proposed ideas, even (and especially) by apparently qualified people, will waste resources and will lead to enormous frustration for your audience of politicians and outraged critics of the current system. The incentives to generate falsehoods are not likely to diminish — if anything, rising spending and stagnant health outcomes strengthen them — so it is all the more important to have an accurate and fast way to detect and deter lies in health care.

Following both Peter Pronovost and Atul Gawande, we call for a “falsehood checklist manifesto” to highlight the major forms of lies in health care today. They are:

1. Top-down solutions

Most proposed solutions to organizational problems are formulated by the CEO or VP of Strategic Planning, who then push their vision down the hierarchy for others to implement, often with minimal input or guidance. For years, we have known that such an approach usually fails.

2. One-size-fits-all, off-the-shelf

Many of the “solutions” offered to health care providers are developed by consulting firms who use a “one size fits all” design that requires little customization. Health care is often the next hapless victim of the latest model which, at best, has been found to work in some entirely different industry and sometimes has not been tested at all. 

3. Silver bullet prescription

New “solutions” are often lauded as the “silver bullet” that will cure all of your ills. Rather than a silver bullet, perhaps the best we can hope for is a lot of “bronze buckshot,” each of which tackles a smaller piece of the problem.

4. Follow the guru

Top-down solutions are abetted by the presence of a visionary Guru with a mystical revelation about what needs to be done. Michael Porter has advocated “value” (quality divided by cost) while Don Berwick has advocated the “triple aim.” Their proposed solutions are followed widely but are difficult to apply in practice, often contradict each other and unrealistically assume that different teams of people will always cooperate to deliver on all the goals.

5. Disruption

Everyone’s favorite Guru, Clayton Christensen, popularized the term “disruptive innovation,”  which involves lower-cost and lower-quality products/services that permeate the underserved (or non-served) market and then migrate upstream to take share away from incumbents who ignore the upstarts. So far no model offering “much cheaper, almost-but-not-quite-as-good quality” care has taken over in the health care sector.

6. Stage Models

Health care consultants, executives and policymakers are very fond of “stage models” planned endeavors in which things build upon prior efforts in linear progression over time. Proponents seem undeterred by the evidence that these models are often simplistic and wrong, just as the stage-based classic models of economic development have failed to be followed by successful economies.

7. Excel sheet planning

There is a common tendency by executives and consultants to express strategic plans in terms of excel sheets all replete with many apparently precise numbers, rosy upward-sloping growth projections and forecasted savings into the future. Unfortunately, nearly all forecasts are wrong or only randomly right and (really) wrong the farther out the forecast. Even worse, expressing plans in terms of excel sheets leads the “advice consumers” to have a false sense of precision and the “advice suppliers” to forget the assumptions behind the forecasts and to check critical thinking at the door.

8. Bandwagons

Every industry is prone to “collective movements” i.e., everyone jumps on the fashionable bandwagon. Health care has suffered from this behavior for decades. No one has bothered to consider that innovations adopted for bandwagon reasons and pushed during bandwagon movements rarely improve corporate performance.

9. Be like Mike

Consultants and CEOs have long encouraged companies to adopt “best practices” allegedly demonstrated by peers. The belief is that if you do the same X and Y as this successful company or leader, you too can “be like Mike.” Of course, no one bothered to ask whether the success of these organizations was due to local circumstances, whether it could be bottled and whether anyone else really had the chops to do it.

10. Buzzwords

If a new strategy is described in terms of buzzwords, head for the exit. These buzzwords get repeated so often they become a shorthand for concepts that most people do not articulate, let alone understand. These can include "synergy," "scalable," "paradigm," etc. We marvel at people in this industry who can string many of these words together in the same sentence (with a straight face).

Lawton R. Burns is the James Joo-Jin Kim professor in the department of Health Care Management at the Wharton School of the University of Pennsylvania and a Faculty Co-Director of the Roy and Diana Vagelos Program in Life Sciences and Management. Mark V. Pauly is the Bendheim professor in the department of Health Care Management at the Wharton School of the University of Pennsylvania.