The Scaling Challenge and People You Know
If you were to become injured or ill, who would do your healing for you? This is not a trick question; YOU do. You and I own our own healing. Outsourcing is not an option. Physicians, therapists, and all manner of healthcare professionals can assist you in your healing process, but make no doubt, the actual healing you do alone. You own your healing and you live with the outcomes. Sure, others are impacted by your outcomes, but only you wake up with them, and you have to deal with them every day.
The day-to-day, minute-to-minute challenges that come with acute and chronic illnesses need little explanation. This, we all know because we have all experienced being sick. We do what we can to avoid it, still, we know we’re not immortal, and something will happen.
The point of all of this is that I often see and hear individuals behave as though it's not true? They default to whatever the physician or “professional” says, seldom with sufficient questions and understanding. Patients enter into healthcare with the vision that professionals will care for things, and healthcare supports the notion with patient satisfaction surveys, community marketing, and often programs whose dubious effectiveness are counted and paraded in front of executives as material accomplishments.
Medicine does wonderful things, still, limits exist, care as they might. This means that you have skin-in-the-game, the buck stops with you. It has not been lost on many patients to see that healthcare organizations want them to come to their hospital, have a good experience, but don’t stay long and don’t come back for at least 30 days.
“We have chosen efficiency over resiliency”
Chamath Palihapitiya
We are abruptly exiting an era focused on efficiency, where we willingly went anywhere to improve productivity and reducing costs. The United States has led this era resulting in a normative expectation that goods would be cheaper, smaller, and more robust than their predecessors. Chamath Palihapitiya, CEO of Social Capital, put it this way, that “we have chosen efficiency over resiliency,” and now faced with a pandemic, we’re finding that we are not as smart as we thought we were.
Choosing resiliency over efficiency will change much of how we act today, along with our expectations going forward. You’ve heard the interest in bringing foreign manufacturing back to the U.S. This will most certainly happen, and with that, costs will increase. In healthcare, this means a bias shift from building buildings to deploying technology, from being inwardly focused, toward seeking to better understand the community around them, into the home.
The healthcare industry provides its services equitably well. Nearly everyone has access to timely, competent healthcare. Healthcare information is easily available; pharmacies have Nurse Practitioners for minor issues on top of which are urgent care facilities and emergency departments. Focusing on productivity, successfully reducing the length of stay, and improved speed-to-recovery across nearly all disciplines. We do not have a healthcare production problem; we have a scaling one.
If we know anything, we know that the healthcare that is personal and specific to each individual is essential in achieving optimal desired outcomes. Artificial heart valves come in sizes, as do intracoronary stents, and drug doses. We would have it no other way.
In the graphic to the left, we measure healthcare that is personal and specific in the vertical or Y-axis, and the scale of providing those services from few to many across the horizontal or X-axis.
We can provide general information to a local group of people through health fairs, but it won’t necessarily be specific. Awareness programs extend that pool of people across a larger population, though still limited in specificity to any one individual. The challenge we’re seeking to address lies in delivering highly personal and specific healthcare to many unique folks. This is no small challenge.
Personal and specific healthcare requires the attention of the patient, their family, and caregivers. Such care is unique, with many detailed and complicated characteristics that need to be considered and addressed.
We’ve community health fairs and multiple awareness programs aimed at informing patients of various clinical risks. Still, these programs fail in getting people to get colon cancer screening, routine breast exams, and properly manage their blood pressure. Optimizing healthcare that scales steers us away from institutions, into communities, and the home.
Individuals Matter
First, there is the matter of the key unit of measure. If the unit of measure is population groups like women vs. men, various ethnic, geographic, or morbidity cohorts, health fairs and awareness programs are fine. The “population” was a key focus of Obamacare, where something called population health was the term du jour. However, when we start talking about you, your child or parent, and close friends, things get specific in a hurry.
It is at the unit of the individual where things matter, this is where things are real. Here is where treatments are decided, applied, and where outcomes are lived out, owned by each individual to its completion. It matters little what the percent of effectiveness or failure might be to a specific treatment. The patient, their family, friends, and local community must deal with the reality in front of them, and it is where healthcare is failing.
A Quiet Army of Embedded First-responders
The barriers to understanding patients go through are astounding. Medicine is complicated, the language is often foreign and confusing, and patients struggle knowing what to ask let alone, what to do. Imagine for a moment, there were a group of experienced Registered Nurses who volunteer to make themselves available, for free, to individuals and families for help, guidance, and support.
Here is a way of looking into the pre coronavirus, centralized perspective, and post coronavirus distributed healthcare system.
The migration from centralized healthcare to distributed healthcare has been in progress for several decades, the coronavirus is accelerating that change in a big way. Many industries have long learned how to manage through distributed labor pools; they have systems and cultures in which such practices have flourished, and neither employer nor employee desire to go back. The current traditional healthcare industry has a lot of thinking to do, but time is not our friend, openness is. In the meantime, find an RN you know and keep in touch, it will be your super-power.
Thomas A. Coss, RN
