5:51 AM
Several of us are lucky to be on a weekly email message list from Gene Lindsey, former CEO of Atrius Health, the largest multi-specialty group in Massachusetts. Drawing on a variety of life situations, Gene is always able to make connections and comments about the state of our health care system. Although he generally refers to issues in the US, his comments are applicable to other jurisdictions as well. This week, he asks and then answers a question, and then he offers a concise summary of the attributes needed in health care delivery organizations. Let's consider his advice after reviewing two descriptions I have offered elsewhere:
After her fifteen year-old son Lewis Blackman died from a series of preventable medical errors, Helen Haskell diagnosed the problems in the hospital by saying, “This was a system that was operating for its own benefit.”
What she meant was that each person in the hospital was unthinkingly engaged in a series of tasks that had become disconnected from the underlying purpose of the hospital. They were driven by their inclinations and imperatives rather than by the patient’s needs. Indeed, they were so trapped in that form of work that they could not notice the entreaties of a seriously concerned mother as her son deteriorated.
Or that of a Harvard business professor who described the financial imperatives of many hospitals in a less personalized, but analogous fashion. He called hospitals “business cost structures in search of revenue streams.”
What he meant was that the business strategies of the hospital had become detached from the humanistic purposes that had led to the creation of the hospital. There was thus a parallel to the individuals’ behavior noticed by Helen.
Gene put it this way:
Why should our industry expect success when we consistently put our own concerns and fears before the needs of our patients? At a minimum, we must align our skills with their problems even if our motivation is pursuing our own interests and financial well being. This is a truth that real service industries take as a given. Many in the traditional professions like medicine, education, law, and even the clergy are beginning to see the need to approach their relationships in a way that is more cognizant of the concerns of their customers who are now armed with enough information to have the courage to push back and ask “why."
And then he offered the following, taken from Crossing the Quality Chasm:
The Ten Descriptors of A Better Health Care Organization
After her fifteen year-old son Lewis Blackman died from a series of preventable medical errors, Helen Haskell diagnosed the problems in the hospital by saying, “This was a system that was operating for its own benefit.”
What she meant was that each person in the hospital was unthinkingly engaged in a series of tasks that had become disconnected from the underlying purpose of the hospital. They were driven by their inclinations and imperatives rather than by the patient’s needs. Indeed, they were so trapped in that form of work that they could not notice the entreaties of a seriously concerned mother as her son deteriorated.
Or that of a Harvard business professor who described the financial imperatives of many hospitals in a less personalized, but analogous fashion. He called hospitals “business cost structures in search of revenue streams.”
What he meant was that the business strategies of the hospital had become detached from the humanistic purposes that had led to the creation of the hospital. There was thus a parallel to the individuals’ behavior noticed by Helen.
Gene put it this way:
Why should our industry expect success when we consistently put our own concerns and fears before the needs of our patients? At a minimum, we must align our skills with their problems even if our motivation is pursuing our own interests and financial well being. This is a truth that real service industries take as a given. Many in the traditional professions like medicine, education, law, and even the clergy are beginning to see the need to approach their relationships in a way that is more cognizant of the concerns of their customers who are now armed with enough information to have the courage to push back and ask “why."
And then he offered the following, taken from Crossing the Quality Chasm:
The Ten Descriptors of A Better Health Care Organization
1) Care based on continuous healing relationships: Care should be given in many forms not just face-to-face encounters. The system should be responsive 24 hours a day.
2) Customization based on patient’s needs and values.
3) The patient as the source of control. Encourage shared decision-making.
4) Shared knowledge and the free flow of information: Unfettered access to medical records with effective communication between patients and clinicians.
5) Evidence based decision making. Practice should not vary illogically from clinician to clinician.
6) Safety as a system property.
7) The need for transparency.
8) Anticipation of need.
9) Continuous decrease in waste.
10) Cooperation among clinicians.
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