We’ve all experienced it. Or at least I have, and I was beginning to think it was my advancing age, declining memory, and increasing forgetfulness. You’re sitting in a room, working on a particular project, when you realize there’s something you need to get from another room. Quickly, you rush to the next room to ….. and then it hits you, you’ve forgotten why you came into the room.
The world of health care today is much different than the one I became involved in as a physician over 35 years ago. But why should that surprise me? The world in general is so dramatically changed from that which I knew then, it would seem reasonable and totally understandable that we’ve had to make dramatic changes in how we work with the population in maintaining health. Or have we? For it seems to me that in many cases the volume-based, paternalistic, top down, cottage industry approach which served us generations ago still has a strong presence, at least intellectually and emotionally, in many in the medical profession.
Most of my life has been centered around the concept of the individual genius, using a unique skill and set of talents to create a piece of art, a great round of golf, a unique new device—you name it, I was inspired by the creativity and genius exhibited by such unique people.
Nothing about me, without me.” Perhaps not exactly presented as promoted by Dr. Donald Berwick, previously at CMS (sadly not true for the future, but that’s another story). It was a mantra used by him in his ongoing crusade to advance the patient-centered concept into our health care system. His energy in promoting the needed transformation from the provider-centered world we presently inhabit to one focused on the patient has been unabated.
Often times when frustrated with politicians, bureaucrats, or anyone involved in trying to solve a difficult problem, we see a reference to “common sense” or the lack thereof. “Why don’t they just use common sense?” “If only they had a modicum of common sense!” “Whatever happened to good old common sense?” Indeed, whatever did happen to common sense> Nothing, and that’s precisely the problem.
Admit it, we’ve all done it. I certainly have, and I suspect most of you take the time or have the interest to read my blogs are guilty of the same action. Frequently, as I rush into an elevator, whether to get to my office or an “important” meeting, I push the destination floor button, and then patiently wait for the door to close.
In my last blog, I began to link some of the thinking from the area of socio-economics with regard to resource utilization (the “commons dilemma”) to our evolving work in addressing hospital readmissions in Minnesota ( http://www.rarereadmissions.org/ ). While the connection is perhaps tenuous, it has created an interesting dialogue, and one that seems worth pursuing. But as is often the case with my musings, it raises another specter that will challenge us as we move this forward.
It all began with a local issue in a distant time, with a pasture, a group of herders, and a limited place in which to graze livestock. It now has become a major concept highlighted in many arenas, which may help us better understand how to transform health care. But it also may be a distraction if not considered in the proper context.
Check, please! No, I’m not impatiently waiting for my dinner bill. I’m looking for a reality check. Such as, does anyone really think we’re ready as a health care system for the upcoming reforms being promoted? We’re only beginning to fully understand what will be needed to implement the patient-centered medical home model (lovingly and legislatively called health care home in Minnesota) when at the same time we are being trampled by the rush to develop Accountable Care Organizations (ACOs). What’s interesting to me is that if I venture outside the Twin Cities metro area, I encounter a significant number of health care providers who don’t even understand what the ACO acronym stands for? Check, please?
One only has to look around to see an abundance of rules being promulgated as being critical to ensure the “right” thing is being done. The mandatory sentencing guidelines imposed by legislative statute on the legal profession, and constraints placed on teachers to ensure that “no child is left behind” are but two examples of an increased effort to provide a lengthy and often prescriptive list of actions and activities to incent the desired activities. In health care, we see an increasing movement among many to develop checklists, and to provide incentives intended to maximize the likelihood that patients will receive the high-quality care they deserve.