Experiencing the joy of being healthy plays a central role in modern life. Health improves the quality of our lives and the lives of those we love.
I certainly don’t need to explain to you, how advances in science and technology are changing diagnosis and treatment and even making it possible for us to cure and prevent sickness and disease way beyond what we could ever have imagined. Breakthroughs now make it possible for physicians and other care providers to personalize medicine for patients. We have a growing ability to predict the benefits of certain treatment options; to detect disease before symptoms appear; and to understand if a particular treatment option may harm or heal a patient.
Recently, I discovered an App where you can request that a physician come to your home if you or a family member is sick or perhaps has a minor injury from a fall. Isn’t it fascinating how mobile devices and innovative entrepreneurs are returning us to the tradition of the beauty of the ‘Marcus Welby house call’?
Likewise, communication technology breakthroughs are changing how we experience healthcare. Today, among other paradigm shifts, we can receive our lab tests via our own patient portal. Whether it is access to our healthcare information or the growing expectations of us to be good patients, serve as our own case managers, advocates and savvy administrators, there is no doubt that communication technology is changing our experience of healthcare.
I stand in awe, at times, at the mesmerizing scientific and technological discoveries that are coming into our lives on a daily basis.
The shadow side of our own progress
Has the complexity come to a point that we can no longer oversee it? Individually, is the pressure to seek, to learn and to integrate new technology and medical breakthroughs so great that it effectively, or perhaps evening unknowingly, undermines our attention and distracts us from what really matters?
Every care provider I talk with is to some degree overwhelmed by their environment – there are new expectations, new approaches to quality systems, new management and measurement approaches, more change programs, greater competition, new science to assimilate, new regulations, new payment models, new IT systems, new instrumentation and now even personal branding of all things. I ask myself, what is most needed to ‘thrive rather than survive’ this incredibly complex system of healthcare?
When we turn to the collective efforts, we discover that the more connected we are through technology, the more disconnected we seem to become. When I speak with ‘patients’ I hear story after story of negative experiences in healthcare. There isn’t a dinner table where I have sat with friends, family or colleagues where on the topic of healthcare, the conversation soon turns to heartbreaking stories of medical errors, poor communication, insensitivity, mix ups, barriers to treatment, and struggles with insurance providers. I ask myself, how can experiences go so wrong with all that we have invested and with so many caring professionals working in healthcare?
Tragically, a recent study from the Journal of Patient Safety found that between 210,000 – 440,000 patients die annually from medical errors in the hospital. Despite our efforts, we continue to find gaps between our written protocols of care and the real-time, dynamic, operational world of healthcare that patients experience every day.
Singular approaches to problem-solving
I see serious problems with the interplay between the forces within the system. Within healthcare we find numerous examples of singular approaches to problem solving and the tendency to separate thinking from doing. We create abstract approaches and concepts that are not rooted in everyday reality. Let’s face it, the healthcare system is enormously complex and interdependent. If you change one aspect of the system, it will have reverberations elsewhere, including unintended consequences. At the political level, we also see these inconsistencies. Likewise, it is not uncommon for market forces and national policy decisions to be moving in opposing directions.
By way of example, close to patient care testing in doctors’ offices is vital to getting rapid results so that the doctor can make a diagnosis with a current picture of the patient’s health status. When test results are available real-time and ‘on the spot’, doctors, nurses and other care providers along with patients and families can talk together before the patient leaves the office. Through this interaction meaningful conversations can occur that lead to changes in behavior, greater motivation around adjustments to diet, exercise or medications – any and all support that is needed to return to health as quickly as possible.
At the same time, there are increasing national trends by payers to require that testing be performed at a large reference laboratory in order to be eligible for reimbursement. So in one direction, we see an expansion in the technology to support rapid, close to patient testing, which is essential to the current national policy direction of value-based healthcare; and in the other direction, the growing national trend by payers to only reimburse for testing performed in large reference labs.
Hope for the future
In 1986, I began my career in public policy as a new graduate of Miami University (Oxford, Ohio) where I specialized in interdisciplinary studies, economics, political science and philosophy. It took very little time for me to discover my mission as a young professional working in the Ohio Legislature and then later in Washington D.C for the American Society for Internal Medicine. I wanted to do my part to improve access to healthcare for the uninsured and uninsurable. Later, I was captivated by the topic of quality in healthcare and specifically quality in laboratory medicine.
Thirty years later, I do see the progress we have made. But my message today is one of both hope and deep concern. I think we need a thoughtful, guided, on-going discussion based on real facts and reason rather than rhetoric, to see if our efforts so far are indeed taking us in the direction we wished and need to go.
As a society, undergoing a tremendous transition in healthcare, we must continually focus on what really matters to us. Perhaps we need to remind ourselves and realize that being healthy is an amazing natural grace. But if that grace itself is taken for granted and we reduce healthcare to a predominantly instrumental-financial system and refer to our care initiatives as an ‘industry’ then we have fallen into the fundamental pitfall of learning.
Could it be the case that our fundamental biases have become a set of rigid beliefs and convictions? In my view, any approach that is blinded to the central principles upon which our ‘care system’ is based will undermine the opportunity to progressively develop a comprehensive system which can learn from it own mistakes.
The world is changing faster then ever. In all fields of science we are wowed by the latest discoveries and the big data. However, I believe it is imperative that we look deeper and begin to ask more human-centered questions about what a comprehensive system of quality and service can be in the next future. I am reminded of the quote by Thomas Moore: ‘just as logic leads the mind, desire guides the soul.”
Of course as a specialist, action-researcher and aspiring scholar focused on learning, I appreciate the value of ‘big data.’ Our challenge lies in using our ‘big mind’ to analyze the data and to evaluate the value of it beyond reinforcing our basic premises.
I believe that we need a third force involved…the force of a ‘big heart.’ Let us remind ourselves of the three main scholarly disciplines in the old Greek ancient times – ‘techne’ (the art of craftsmanship), ‘episteme’ (justifying our beliefs) and ‘phronesis’ (guiding intelligent actions that lead to wisdom).
We are challenged in these modern times to reflect upon our basic assumptions, theories, methods and practices. Nobody seems to have the time. In my worldview, a new area calls for a new approach. Rather than participating in ‘Vision Labs’ or the surfing on the next wave of systems reengineering, I strongly believe that the real breakthroughs within our care system will emerge out of people engaged in modern ‘Learning Labs.’
I invite all caregivers and administrators to participate in a learning process, preferably multi-disciplinary, and to reflect upon our practices, both structural and cultural, to search with me on a contemporary quest for the soul of healthcare.