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Chaos and Organization in Health Care 1st Edition

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ISBN-13: 978-0262013536
ISBN-10: 0262013533
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Editorial Reviews

From Publishers Weekly

This pair of M.D.s build the case for fixing the nation's fragmented health-care system with a lot of high-tech grease and a change in attitude. Long on statistics and occasional medical-business speak, but still readable, the pair from Partners Healthcare System in Boston (Lee is network president, Morgan is CEO) declare the fix is simple—tight organizational structures, with salaried physicians, electronic medical records, doctors working in teams: in short, a system like Cleveland Clinic's, highlighted by President Obama. But given the current congressional infighting, the good doctors' dream may be doomed. (Oct.)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.


Dr. Lee and Dr. Mongan present a compelling vision of a more efficient, reliable, and patient-centered healthcare system. The authors' call for fundamental payment and delivery system reform to achieve an integrated delivery system accountable for achieving the best health outcomes and prudent use of resources is right on target. Strong leadership from the provider community like this is exactly what's needed to lead the U.S. health care system towards higher performance, lower cost, and better care.

(Karen Davis, President, The Commonwealth Fund)

The toughest part of health reform will be after the politicians finish with us, and we health care insiders have to figure out how to create a higher-quality system that is more affordable. Refreshingly frank, non-partisan, and easy to read, Chaos and Organization in Health Care takes on this challenge and lays out a vision for how our system can achieve integrated care. Lee and Mongan are not afraid to take on the sacred cows of the delivery system and they do so in an entertaining way. I highly recommend this book to physicians as well as anyone else involved in improving our health care system.

(Robert Galvin, Executive Director of Health Services and Chief Medical Officer, General Electric)

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Product Details

  • Hardcover: 296 pages
  • Publisher: The MIT Press; 1 edition (September 21, 2009)
  • Language: English
  • ISBN-10: 0262013533
  • ISBN-13: 978-0262013536
  • Product Dimensions: 6 x 0.8 x 9 inches
  • Shipping Weight: 1.2 pounds (View shipping rates and policies)
  • Average Customer Review: 4.4 out of 5 stars  See all reviews (7 customer reviews)
  • Amazon Best Sellers Rank: #1,170,238 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

32 of 44 people found the following review helpful By Dr. Terrence McGarty on October 6, 2009
Format: Hardcover Verified Purchase
There have been a great number of books analyzing health care over the past year and one suspects that this wave will continue. The book by Lee and Mongan entitled Chaos and Organization in Health Care (MIT Press, 2009) is one of the more recent. The premise of the book appears to be that the delivery of health care has problems because it is in an organizational state of chaos and if order is restored by the means proposed by the authors then all things will improve.

On page xi they specifically state that "the solution is organization" and it is from this assertion that they continue to build their argument. On page xiii they assert their proposal that a "tightly structured delivery organization" is the ideal and they proceed to use several examples throughout the book. Before continuing, I would introduce an interesting historical observation. When I spent time in and around Longwood Avenue, the Harvard Medical School area, in the 1960s, I could actually park my VW in the lot in front of one of the hospitals. By the late 1980s I had to use a multi-story garage, for what I thought was a great fee of $8. Last week I used the gigantic subterranean parking edifice for $30. The authors seem to recommend that the patients come to them, where they are collected as a group, but the vignette on parking just is the tip of the exclusion iceberg. It is quite difficult to get patients to trek to a single location for intermittent or routine care, they are all too often difficult to get to, especially for a patient who would then have to take great time from an already pressured schedule. The answer has been the single or multi-practitioner practice.

On p xii the authors speak of team based solutions to treating Diabetes.
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3 of 4 people found the following review helpful By Dr. Joseph S. Maresca HALL OF FAMETOP 1000 REVIEWER on April 22, 2010
Format: Hardcover
The authors describe a methodology to transition
from chaos to organization in the existing medical
delivery systems. The general practitioner is the
initial party in the system which evolves to the
full service clinic. I believe that the book
should have described the development of networks
of specialists which provide the complete diagnostic
profile for a patient.

Oftentimes, the general practitioner is limited to
the basic examination, bloodwork, urine, chest x-ray
and ultrasounds. The specialists do the complicated
diagnostics like MRIs, chronic pain management, surgery,
the musculoskeletal network, physical therapy
and nutrition management.

The authors believe that dramatic cost reduction can
come from strategic application of medical technologies,
automation, the evaluation of threats, deployment
of aggressive treatment regimens and collaborative
teamwork to avoid hospitalization at all costs.

The lowest real growth in health care expenditures
is in Germany, Italy and Austria. Good care is
defined as safe, effective, patient-centered,
equitable, timely and efficient.

The authors provide some high success stories
like the implementation of Gefitinih to thwart
non-small cell lung cancer in a real life story.
Overall, the work is a good starting point
for implementing improvements to the existing
health care systems.
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6 of 9 people found the following review helpful By Donald H. Millikan on February 6, 2010
Format: Hardcover Verified Purchase
Recommended by Henry J. Aaron of the Brookings Institution, this book by Thomas H. Lee, M.D. and James J. Mongan, M.D. compares the provision of health care from individual physician providers all the way to complex integrated systems such as Kaiser Permanente. The book is based on the extensive experience of the authors in this field, along with carefully researched references. It is the most important contribution I have found for understanding major issues which will need to be addressed in reconstructing our health care systems. The authors do not take a "one size fits all" stance, but they provide careful analysis of many levels of organization.
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6 of 9 people found the following review helpful By Glenn on November 25, 2009
Format: Hardcover Verified Purchase
This new book frames the healthcare reform debate in the light of real data and workable approaches. The authors make the case for integration of physicians into health networks as the best future for medical practice. Their focus is mostly on direct physician care and not the full spectrum of providers that will be needed to deliver basic care over the next decades, but the arguments and data they present are applicable to the whole system. If you want to be well informed about this critical issue, this book should be a key part of your education.
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