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by Yaneer Bar-Yam
Step II: Empower Workgroup Competition

There is a third: empowering workgroup competition. Groups of care providers who together can be responsible for medical outcomes and other performance metrics compete against other groups in the same hospital and between hospitals. Workgroups must become teams in a peer competition to improve care. This team competition approach combines the best aspects of both the free market and centralized management; it allows the spirit of competition to spur advances and improve performance, while still allowing management to set objectives.

In free-market competition, the goal is financial gain. In workgroup competition, the objective is to be a top performer according to carefully designed metrics that measure both cost and quality. This kind of competition works for sports teams, students competing for grades, and in other competitions where the goal isn’t just to make money.

In order for medical care to improve, the people engaged in providing that care, who know the most about what to do, must be the ones who have control over care decisions, and must be the ones with responsibility for outcomes. However, performance should not be measured at the level of individual doctors and nurses, because outcomes often rely on an entire workgroup’s performance—e.g., how nurses or physicians communicate information across a shift change has a huge impact on outcomes, and communication relies on how people work together.

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