The Control That Matters In Health Care

In health care, there is much talk of control. One of the biggest issues is controlling the spiraling cost of care.

In the same breath, we have become transfixed by outcomes for any given episode of care. This is thought to help control costs – the costs that are faced right now, what I call the upstream costs.

But over the long-term, the control we need to discuss is locus of control. This is the control that will ultimately provide health care with true, epic reform.

Upstream costs: As much as I believe that outcomes are important, they generally fail to quantify some key issues. Sure, we need to know that Intervention A or Strategy B produces Outcome C in patient population D. All are very important.

But these are all upstream issues. They still don't address the downstream issues: the cost of recurrence and multiple episodes of care. Yes, we may be able to effectively deal with an episode, but are we changing the rate of recurrence? More importantly, are we changing a patient's perception of their self-efficacy? Are we changing their locus of control?

Locus Of Control: An individual with an external locus of control tends to view their life as being the result of external forces. In health care, it is a perception that their care and treatment effect is attributed to someone other than themselves. It also leads to the next problem: when the next episode occurs - and it will, more often than not - their external locus of control drives them to seek care.

An individual with an internal locus of control tends to view themselves as having an active control over their world. In health care, it is a perception that their care and treatment effect is controlled by their own active involvement. So when the inevitable next episode occurs, they implement self care strategies, first and foremost, before pursuing other avenues.

The majority of current health care strategies are very external locus-oriented. But as we know from addiction research, you can't do something for someone and expect their locus of control to change.

We Need To Change Locus Of Control: Although we are seeing plenty of studies and data that reflect outcomes for an episode of care, we need studies that examine a change in locus of control over the course of an episode of care. The results of this could have a profound impact on our system of health.

If we could assess, via pre- and post-care questionnaires and the like, a change in a patient's self-perception, then we would have a real game changer. The strategies that actually promote a change in locus of control - those that have the potential to truly impact downstream costs - would become the preferred approaches to care.

Transformational Learning – More Than Just Cutting Costs: Outcomes may be important, but promoting transformational learning is a far more important long-term goal. Changing a patient's self image and self efficacy is far more valuable that any "treatment" on its own. Beyond this, imagine the value of a treatment intervention that not only changes the ability of the patient to self-treat, but their perceived ability to affect change in the first place?

This is the control that matters in health care. Let's approach the problem accordingly.

Photo credits: Jeff Kubina

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