The Great Healthcare Status Quo
On a daily basis, I am introduced to new people from all walks of life. Some sit on the board of directors, some are CEO’s, some are President’s, some are middle managers and other administrators, some are investors, others are entrepreneurs, and some are physicians, nurses, case managers, and even patients.
I listen to people talk about the big challenges in healthcare. It costs too much, we have a shortage of trained professionals, and our communities live an unhealthy lifestyle.
I learn about strategies to take costs out of the system, to be more efficient, to increase productivity, to improve utilization, increase ROI, improve RVU’s, and to ensure we maximize our bottom line.
While at the same time people are taking costs out of a system and trying to make it more efficient, they turn around and spend $500M to build new audacious buildings. They get excited in telling me of the new hospital, the new tower, the new cancer center. The race is on to build bigger, better, fancier buildings and stuff as much technology into them as possible.
This is healthcare’s status quo.
Each time I attend a conference I meet investors and entrepreneurs that have the next big thing, the next solution, and promise to answer all of our healthcare problems.
Everyone has the promise of the unicorn.
Yet when I ask people what is the problem they are solving for, no one can give me a real answer, or at least one that draws a straight line back to why healthcare exists…
The “Me in Medicine.”
Healthcare was filled with the greatest leaders and minds of our times. People like Madam Curie, Florence Nightingale, Dr. Elizabeth Blackwell, and Dr. Jose Delgado.
Healthcare used to be led by the people that cared for those living in our communities, the physicians.
The very people responsible for understanding my symptoms and helping to make me feel better were the same ones running the business of healthcare.
They had minds that were inquisitive, a thirst for curiosity, a drive to investigate uncharted waters and new territories inside of our bodies. They wanted to see beneath our skin, into our organs, our brains, and even draw a map of the very matter that makes us all uniquely human.
Our healthcare leaders used to be the people that lived in our neighborhoods, grew up with us, shopped at the same stores, broke bread at the same restaurants, went to Sunday services, and cheered our children on at sporting events.
We had leaders that had empathy for the community.
Then it all changed.
We removed the MD, the Ph.D., the MD Ph.D., the MSc from the leadership teams. We decided to replace them with the MBA, the BA and bought the BS that they would run our healthcare business more efficiently and effectively.
The new leaders decided to borrow from the best minds of manufacturing and to implement the Henry Ford way into healthcare. Once they created the assembly line then it was borrowing from Toyota to implement the process improvements of Six Sigma, Lean, and become ever more efficient.
The new buzz words became process improvement, asset management, productivity, utilization, and standardization.
Care pathways were created in hopes of standardizing our processes so that all people would get the same care and the system would produce the best outcomes. We shared best practices so that we could quickly scale and reproduce the same care across the board for the entire population.
We accelerated to the mean, scaled to become average, and normalized to mediocrity.
We created rules to follow based on ICD-10’s, MRN’s, and CPT’s. We instructed and rewarded physicians and nurses for following the rules. In a matter of a generation, we were able to transform healthcare from an ecosystem that cared about people to a system of interchangeable parts with interchangeable people.
We turned our greatest minds into nothing more than obedient workers smart enough to follow the rules, run the machines, and file the paper work yet dumb enough to passively accept less money, higher premiums, higher deductibles, less retirement, and average healthcare.
We removed all the sweetness from healthcare and yet we lead the globe in obesity. We have more people with diabetes. We have a nation suffering from heart disease, high blood pressure, stroke, and cancer. We have access issues in communities to offer even the most basic care to the most in need.
Healthcare no longer produces Lamborghini’s. Everyone now produces Geos. We receive a cheap product that generates revenue for the “big bosses” but doesn’t produce the value or delight defined by people as patients.
Leaders moved so far away from the people in our communities that they have no clue what fucking matters to them.
So they generated a new set of buzzwords.
Now we hear about patient experience, engagement, and empowerment. Yet healthcare doesn’t really want a person to be engaged in their care. They do not want informed patients with questions, opinions, and armed with research, they want compliance. They want to capture people as patients that will follow the rules, follow the instructions, and follow the assembly line to produce average care.
They use data models, rubrics, and simulation models to generate insights on what people as patients want or need. They create broad generalizations and act on the insights.
So they insert more technology to replace more people and to remove more connections. We are left with a system of more interchangeable parts with more interchangeable people.
What the original leaders of healthcare understood was that people as patients are not interchangeable. That the signs and symptoms of Mrs. Smith are inherently different than Ms. Jones and while they may end up with the same ICD-10 the way in which they both measure a successful outcome is different.
What physicians knew over doctors was that caring and healing people are an art. The only way to make good art was to take the time to listen, observe, understand, and connect with their patients. It was a risky business to be personal, emotional, and to share in the lives of the people in their community. Yet the reward was to know that they made an impact in the lives of people as patients on their road back to health.
Because what the greatest minds of our time always knew, was that people get sick, and that is not interchangeable.
They knew that without Me there was only “dicine.”
The art of being a physician is healing people.
That happens at the N of 1.
Let’s change the status quo.
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