Yesterday, my 97-year-old physician father-in-law died. His longevity was the result of great medical advances during the past two decades, rigorous self-care, and vigilant and loving family caregivers who helped him live out his days in dignity and comfort.
Genetics were against him. His father died at 58 and an older brother died at 61, both of heart disease. To manage his cardiovascular risks, my father-in-law embraced prevention through diet and exercise, and relied on science and medical adherence – even successfully seeking an ablation for a reoccurring arrhythmia as he neared 90. His actions enabled him to exert a measure of control over his life journey.
Throughout that journey, his medical care was exemplary, but during the final 13 days of his life – 12 spent in a hospital and the last precious day at home, where he passed peacefully from one world to the next, surrounded by people who loved him with all their hearts – I saw what America needs to do to improve care, comfort and costs. I saw that even in state-of-the-art care settings, much work needs to be done to improve collaboration and performance in the service of the patient.
Seven years ago, I penned a piece on the fragmented medical system. I wrote that our system of care is not patient-centric, it is self-centered. While the intention of health professionals to help and heal is exceptional, it’s unclear whether the system they work within is set up to enable them to succeed in complex care situations.
When Finn Partners released a survey in February 2016 on our fragmented health system, I wrote that despite “the talk, the concept of consumer – in this case, the patient – as the king has yet to be realized within the health community. Health professionals, payers, the pharma industry and policy decision-makers have a responsibility to be better patient resources. Providing a clearer path for patients to navigate the system may improve outcomes and reduce costs – it’s still a missing magic ingredient.”
Respect for Patients Must Be At the Heart of Care
Staff is overstretched everywhere now, and that impacts collaboration and coordination of care. One nurse’s comment in response to information shared by one of my father-in-law’s caregivers exemplified this persistent and underlying problem: “I don’t have time to read the My Chart (EHR) file.”
During the 12 days my father-in-law was hospitalized, he had different 10 nurses assigned to oversee his care. The hospitalist assigned to him changed three times. The nephrologist also rotated. Staff overlooked the sign posted over my father-in-law’s bed that stated: “Make Sure Patient Has Hearing Aids On,” and diagnosed him with cognitive challenges. And, despite the sign and constant caregiver reminders to floor staff, they first lost one of his hearing aids and then the other days later – $6,000 of high-tech that had connected him to the world, gone.
Forget Interoperability Nurses Have No Time to Read EHRs
If care providers do not have sufficient bandwidth to read about the medical history of their patients, you can forget about interoperability playing a role in improved care. If the system does not demand that caregivers look over recent tests conducted by other physicians – or allow them the time to do review – then you can forget the optimal use of resources. No matter how innovative medications, treatments or modalities of care are, if these elements aren’t being effectively coordinated for the patient, those therapeutics may as well not exist.
My friend and industry colleague John Nosta, an innovation theorist, often says, “Cultures crushes innovation.” These past two weeks, I once again saw the “Nosta Theory” at work. To be clear, we should not be pointing the finger of blame for this situation at physicians, nurses or allied health professionals on the hospital floor. Healers want to heal just as much as those who are ill want to be helped. But care professionals have to work within the system that the hospital creates, and if the system does not support their efforts or make the best use of their abilities, energy and dedication, what is to be done?
Change Starts with Awareness
In one of three books that he published, my father-in-law, an internist, psychiatrist and sports psychologist, wrote: “When people say, ‘I’ll never change,’ what does that mean? They might mean, ‘I’ll never be able to change my awareness.’ And they may not realize that such a change is often the first step in changing other aspects of their experience.”
The United States boasts one of the most advanced health systems in the world, and leaders within the system seem fully aware they need to change. It’s time to build on that awareness and take critical steps toward improving health delivery and coordination of care – and to move from a system that leads directly to health professional burn-out, avoidable deaths, and spiraling care costs to one that puts people – patients and their caregivers – first.
[This Medika.Life article is dedicated to caregivers, who advocate for their loved ones with courage and hope. It is dedicated to patients who must secure their place at the decision-making table. It is dedicated to health professionals who must be given both the tools of innovation and the supportive culture of collaboration to do their best possible work toward healing.]