Goal Congruence, Incentives, and the Need to Blog

It's been 4 weeks since returning from Haiti. As I take my last chloroquine tablet to prevent malaria, I am in Boston for my weekend with my classmates at the School of Public Health Masters Program in Health Care Management. Here I am surrounded by brilliant people and many of the world's greatest and most sophisticated hospitals. We just had our final session on organizational control and management, with an exam focusing on aligning mission, goals and incentives in complex systems. It is a tremendous difference from last month, when my concerns were antibiotic dosages, mosquitoes, and providing basic medical care. Yet the concepts for a simple hospital in Haiti are similar. If we are to provided care for each other, how do we do it within the constraints of our resources? I would venture to say, that on a dollar for dollar basis, the impact on health by expenditures is far greater in Milot.

I have learned that more is not always better, and that in many cases we create incentives that inhibit, rather than encourage us to meet our mission. As we anticipate providing more coverage and expending more of our GNP, we must assure that the improvement in health and function is commensurate. The WSJ discussed a new immunotherapy for prostate cancer that will cost $90,000 for 3 doses. There is a statistically significant increase in survival of several months. If it's you, and you're not paying for it, why not use the therapy? But on a broader societal basis, is this appropriate? We need to take a hard look at what the goals are, and make sure that how we support and incent those behaviors is congruent with those goals.

So after 4 weeks back, what goals am I trying to reach, and why do I continue to post new blogs? I acknowledge that I do not have fresh stories from Haiti to tell, and appreciate that there are still some of you out there reading my thoughts. We all write for different reasons. As I continue to integrate these experiences and make decisions about the future, sharing these observations with you gives me some clarity and I hope gives you some new perspectives. I know that I have been touched by your own comments in Facebook and other venues about your lives. By writing our thoughts down to share with others, we each gain new understanding of the world around us.

And in the end, it is that feeling of the human connection, even if via a blinking cursor, that makes our lives richer.