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Taking providers beyond the ‘Controllability Principle’

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Robert Simons and Robert S. Kaplan of the Harvard Business School write in in NEJM Catalyst about “the entrepreneurial gap applied to health care”

Among their observations:

Value-based health care increases providers’ accountability for patient outcomes. Many physicians have resisted taking on such increased accountability, claiming that patient outcomes are influenced by many forces outside their control, such as care provided by other clinicians, patient compliance with post-acute and rehabilitation care, and the quality of external rehab personnel and facilities. These skeptics are, in effect, invoking the well-known ‘Controllability Principle,’ in which managers are held responsible only for resources and outcomes that they directly control.

“Yet contemporary management practice advocates the benefits of holding individuals accountable for results well beyond what they can immediately control. The difference between accountability and control is called an ‘entrepreneurial gap,’ evoking the Harvard Business School definition of entrepreneurs as those who pursue opportunities — internally and externally — without regard to the resources they currently control.”

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