'Anything easy ain't worth a damn.'

FB001I grew up in Columbus, Ohio, where football Saturdays rivaled Sundays for the holiest day of the week. As such, the esteemed words of the likes of Urban Meyer, Jim Tressel and Woody Hayes (arguably Ohio State's best coaches) were as highly revered as the football team itself.

"Anything easy ain't worth a damn," Woody Hayes so famously — and eloquently — said. (And he should know. Coach Hayes led the Buckeyes to five national championships, 13 Big Ten Conference titles and finished his 28-season career at Ohio State with a 205-61-10 record.)

In terms of the values he upheld in his work, "ease" didn't rank high for Coach Hayes. Convenience, speed, comfort — these weren't things he thought made for a winning team, and I would venture to say most successful people would agree.

Ease, or the absence of difficulty, can be a dangerous enabler. We arguably place less value on things that come easily. They don't require investment on our part, in terms of time, effort or another commitment that carries value. Ease can also fool us into acting more carelessly, a phenomenon Brian Millar suggests in his Wired article called "Why We Should Design Some Things to be Difficult to Use." He writes about the late economist Gordon Tullock and one of his pieces of design logic that could theoretically reduce car accidents: install a spike protruding from the steering wheel that is directed at the driver's heart.

"User friendly? No. But it would certainly make everybody drive very, very carefully," Mr. Millar writes.

Mr. Millar's article speaks to the design of cars, cameras and computers, but as the healthcare industry is undergoing a grand redesign of its own, I can't help but think many of the same principles carry over.

Redesigning the American healthcare system will be anything but easy, yet this value seems to be exactly what many professionals in the industry expect. While we shouldn't always expect things to be harder than they are, we also can't expect them to be easier than they are. And redesigning a $2.2 trillion system (as estimated by PricewaterhouseCoopers) shouldn't be easy. What it's supposed to do is result in the best system we can conceivably offer — safe, effective, efficient and centered around the patient.

Take the Medicaid Sustainable Growth Rate fix, or the "doc fix." Since 2003, Congress has passed patches and temporary fixes to stall Medicare reimbursement cuts to physicians. President Obama has proposed repealing SGR fixes, which different reports indicate could cost anywhere from $115 billion to $175 billion over the next 10 years. What started as a 4.8 percent reduction in payment has climbed to a 24 percent cut in payment, with the large political question of how to pay for that.

Could this have been avoided if Congress had forgone the easy fix and made the difficult decisions to proceed with cuts 15 years ago? There's no way to know for sure, but I'll take my chances and say yes.

There is also the adoption of EHRs and the progression of meaningful use, which will not be easy transitions. But again, the point isn't to make it easier. The point is to make it better.

In his article, Mr. Millar discusses the idea of designing things to make it easier to do something badly.

For instance, many clinicians use the copy-and-paste function to place information into EMRs to save time. A 2013 study found notes entered by 82 percent of residents and 74 percent of attending physicians contained at least 20 percent copied text.

This feature, seen by many as "user friendly," also makes it easier to do just that — makes it easier to do something badly. Copy-pasting is linked to a variety of errors, including outdated information, redundancies, the spreading of false information and an inability to identify when the documentation was first created.

Sure, paper records are no longer ideal, but such carelessness wasn't an option on hard copies of records. Typing individual entries into individual fields isn't a design flaw — it's a feature that demands a clinician's attention, effort and helps ensure the patient's record is as accurate as it can possibly be.

To be clear, I don't want to suggest we make things harder on ourselves. We already deal with enough hardships and difficulties on a day-to-day basis. Instead, I'm suggesting we let go of the idea that there is always an easier or simpler alternative, especially as we move forward with the redesign of the healthcare industry. So often what we make easier for the lawmaker, physician or executive ends up being harder for the patient or consumer.

"We should be wary of only designing for ease of use," writes Mr. Millar. What's easy may not be best. The industry needs to undergo a lot of change, but it's never going to improve if we don't embrace the difficulties along the way.

Facing, and then surmounting difficulties, equals growth. It translates into progress. If this redesign were easy, it wouldn't be worth it, and we wouldn't give a damn.

(Photo courtsey of The Ohio State University Libraries: http://library.osu.edu/projects/woody-hayes)

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