Amidst the frenzy of critiques of the US health care systems (yes, there are several), what is still working are the workers, the health care providers - from community health aides and orderlies to chief nursing officers and medical staff leaders – who continue to slog through the detritus of the systems’ dysfunctions, get up every day and try to figure out how to care for patients, their families, and their communities despite the incessant shifting obstacles to meeting that goal. The vast majority of health care providers made their occupational choices with one thing in common: they thought it would be a way to help people suffering from disease and its consequences. Most keep trying to do this.
Reluctantly, I am going to use a war metaphor to amplify. The national discussion on wars often emphasizes the “troops on the ground” and their perceptions of their situation. I try to imagine all those soldiers being asked to divert themselves from their primary responsibilities to collect “performance metrics” so we can find out where they are failing to do their job or making errors. I picture us posting these shortcomings so we can prove that we are transparent. I try to imagine literally hundreds of external experts creating elaborate documents and initiatives designed to ignore the larger enterprise of war and instead creating bureaucratic monsters eating time, resources and even lives in an effort to tinker with the system. I try to imagine soldiers incessantly being blamed in the media for the obvious human errors that wars create. I try to imagine benchmarking this war against other wars so we can see which war is more wonderful. Enough!
I like to think that my analogy is germane because the two groups share a common goal: keeping Americans safe.
In the next cycle of change, I would hope we might get back to the overriding mission in health care: to take care of people faced with challenging health experiences. Quality care and cost containment are polar forces to be balanced. Using the tools of cost containment to assess quality care is at best naïve. Try measuring compassion or the tears of a child watching her mother die of cancer. “Not everything that can be counted counts and not everything that counts can be counted.” (A. Einstein) A bit more emphasis on the mission might change the dialog.
I would recommend the President, his cabinet members, and all the members of Congress try an anonymous three-day hospitalization. They could go through the admissions process stating they have no health care coverage, for starters. The “boots on the ground” might inform the discourse, unveil the impact of provider shortages, demonstrate the nuanced nature of giving good individualized health care, reveal the cost of cost control measures, and introduce them to some providers who are trying to give quality care despite all the disturbances swirling around them.
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