|
 I started in healthcare a long time ago as an orderly and learned a lot from nurses. In my later career as a vascular surgeon, nurses always taught me something.
I remember in particular, Sister Maureen, the first head nurse I encountered in my fledging practice.
Sr. Maureen ran a well-oiled surgical unit; things just worked on her floor. Staff was attuned to patients and problems. She knew what was happening almost in real time and greatly helped our surgical group provide better care.
When Sr. Maureen retired in the early 1980's, I was surprised. Her health was good, she obviously loved her work, and she was amazingly competent.
"You know I love this job but it's just getting too complicated," she said. "I can't keep up."
At the time, I thought Sr. Maureen was just slowing down.
How wrong I was.
Uncoordinated & Cumbersome
It took me a long time to discover Sr. Maureen was correct. It was too complicated, but it wasn't just her problem.
She was speaking about the well intentioned but cumbersome, uncoordinated way we work together. It was too complicated and none of us were keeping up.
The ongoing rash of proposed healthcare legislation unleashed this summer to reform our troubled system shows most healthcare organizations still aren't keeping up.
However, a few - those who empower nurses and other workers at the point of care - are starting to manage the complexities of healthcare far better than most.
I began my journey of understanding in 1992, when I fell out of a tree and broke my neck. Disabled for 6 months, I discovered my recovery depended on many great people, like the "Sister Maureens" of the world, who went the extra mile to make sure I got what I needed.
Thank goodness healthcare attracts those kinds of people because the "system" itself often didn't help much. In fact, it often got in their way.
I learned that although our healthcare system consisted of many wonderful parts - dedicated, smart people, sophisticated technology and wonderful facilities - as a patient, I received less than their sum.
Feeding the Beast
After my recovery, I became part of the senior executive team of a great healthcare system that set out to fix the problems. First, we gathered data. How else would we know what to do?
Then we had meetings - lots of meetings - to analyze the data and plan and predict solutions.
We also had many experts eager and well paid to help us - consultants, vendors, advisors, technology companies, regulatory commissions, government and many others.
Finally, we implemented the solutions back down into the workplace. We set new policies, designed better processes, bought technology, did improvement projects, implemented new budgets, hired good people, trained them better, fired those that didn't fit, etc.
It didn't work as well as we planned.
I continued my surgical practice part time and discovered some of my best efforts as an executive made my life worse as a clinician. New computer systems slowed me down. Cost cutting and downsizing interfered with my patients' care. Safety initiatives increased cost. Meetings and improvement projects took me away from my patients.
I also discovered the other side to this problem. The resources and flexibility I needed as a clinician were a nightmare to me as an executive facing unfunded mandates, declining reimbursements, the Joint Commission on my doorstep, new computer systems and technology to implement, and more meetings than I could ever imagine.
I began to feel like Sr. Maureen - it was getting too complicated.
|