Taking a top-down approach to government initiatives has been scorned by New Public Management advocates, who claim that a top-down hierarchical structure hampers efficiency, fails to meet the needs of society and lends itself to poor outcomes. Yet, today’s Meaningful Use initiative is noted for taking a top-down approach. If scholars are right, then Meaningful Use should flop – yet, it continues to thrive.
In Ken Terry’s recent post, British EHR fiasco shows U.S. may be on the right track , top healthcare officials noted that the success of implementing EHRs and Meaningful Use is heavily dependent upon establishing a horizontal hierarchy to include input from physicians, providers and patients. They also point out that a top-down approach to Meaningful Use will not work, because HIT is implemented on a local level not national level.
Since the Health IT Policy Committee is focusing on meeting Meaningful Use agenda items instead of working hand-in-hand with the private sector/providers to incorporate their needs and desires, the initiative is predicted to meet some resistance beginning in Stage 2. If applying top-down approaches to government initiatives typically result in failures, then when is it appropriate to apply this approach and why is Meaningful Use experiencing such wide-spread acceptance?
The prediction is that providers will begin digging in their heels during stage 2, because their voice isn’t being heard. However, that mentality grossly contorts providers and provider’s views on care. Providers (and payers) advocate for top-notch quality care that produces results. The healthcare industry isn’t against Meaningful Use, it isn’t against improving care and using new technologies to add value and decrease costs. As a matter of fact, healthcare executives have made achieving Meaningful use their number one priority.
The truth is, Meaningful Use is going to be a success, because the healthcare industry is embracing the initiative. Professionals aren’t arguing about incentive or a command-and-control structures, they aren’t digging their heels in because of procedure. Instead, healthcare industry employees have risen above the bantering and focused on the value of implementing EHRs, applying analytics to overcome healthcare hurdles and transferring data to help better serve society.
Perhaps it is time to praise healthcare employees and leaders for looking past the difficulties associated with top-down approaches and instead applying a “can-do” attitude in the midst of change.
