Reflecting on the healthcare system while waiting at the hospital for a loved one

pnblog — Wed, 30 Sep 2009 03:12:00 GMT

Often when we talk about healthcare reform, it can be a rather abstract discussion -- you watch some tv show with ‘experts’ reflecting on some 20 page bill or hashing through the merits of a public insurance option. Last week, however, all the intellectual and abstract ideas were brought into something very personal for me and my family.

My wife had a Hysterectomy, and I spent three days at Swedish hospital in Seattle caring for her. With all the waiting time, it was hard not to reflect on the experience and think about it in the context of health reform. I’m happy to say that my wife is now recovering on schedule, and she’s given me permission to share the story and my insights.

Once she had decided surgery was her best option, we became even more avid information seekers; we shopped for the procedure with the best outcomes and then the surgeon with the most experience and best quality results for this procedure. The best available counsel we found was for a Robot-Assisted Hysterectomy because there was less risk, less pain and faster recovery times vs. the alternatives. We didn’t have to shop for ‘price’ (thanks to Microsoft’s benefit plan, but that is a different future post)…but even if that were the case, we probably would have chosen a more ‘expensive’ option if it meant less risk and more productive days -- getting back to normal life as quickly as possible.

We all know that surgery can be pretty scary. Throughout the experience, everyone from the doctor’s office to the staff at Swedish helped to make the experience a positive one, allaying any fears and making us feel comfortable and confident. We often forget that healthcare is truly a people business. In just three days – the number of different people we dealt with was amazing -- five docs, seven nurses plus the ancillary folks (lab techs, transport and other helpers). They all took time to connect with our emotions while doing their jobs.

Swedish is leveraging technology to improve their systems. You see it throughout the organization, starting in the lobby, with signs advertising the hospital’s new EMR system. During the course of our stay, when there was time I asked various staff members about their experience with the new EMR, and they were positive about the system because they had all the information in one place. While a common complaint was that the data entry took them more time, they felt overall it made them more productive and effective.

This highlights that we need to remember that technology is a means to an end. It is NOT the introduction of technology that will make a difference, but rather how leadership leverages the right technology to make a difference…in both quality results and economic outcomes.

I also saw a real focus on patient safety, starting with the pre-op processes. Each member of the care team carefully checked her arm band, her chart and asked several specific questions to be sure she was getting the right action. For us, the repetition became frustrating, but if this process were to improve patient safety, then it would be worth it. Despite the technology investments, the core safety process was in the human factors.

After the surgery was completed, she spent two days recovering in the hospital. This was a day longer than originally planned due to very low blood pressure and a declining hematocrit. While I used the guest Wi-Fi for work and email, it was even more critical for answering key questions about her condition, the trade-offs, the next steps – which helped me to get some context and understanding to a) engage more thoughtfully with the care team about questions/choices and b) assure my wife about what was going on during the long time periods when neither doctor or nurse was around. I think hospitals should consider leveraging their video and wireless infrastructure more effectively for patient specific education and connecting with their care teams. This is potentially a big opportunity for improved patient compliance and care team coordination.

Because the low blood pressure persisted, I called her primary care physician to get her baseline BP. If we had stored this information in HealthVault, I wouldn’t have had to make the call – I would have just been able to look it up. Furthermore, I would have preferred to have gotten her discharge information automatically transferred to HealthVault. We were given paper copies. This should be easier.

So, what’s the moral of this story?

· We can’t lose sight of innovation and there’s a risk that could happen if the government were to become the primary funder of health.

· Technology is a means to an end, but we have a long way to go to figure out how to use it smartly.

· We can’t lose sight of how important the personal aspect of healthcare is. The emotional support and human caring delivered by the care team was the critical component of our overall satisfaction.

This experience reinforced for me that a ‘healthy’ health ecosystem requires consumer choice -- it is a critical component to the effective functioning of markets and innovation. We made the decision to ‘save time/hassle’ vs. saving dollars as we do in other aspects of our lives. This really drove home for me that the debate about ‘rising health care costs’ doesn’t really account for improved patient outcomes in terms of fewer lost days of work/productive living. I am all for comparative effectiveness of various options and knowing what things cost, but it needs to include patient values -- like less pain and getting back to normal faster -- or it may lead to bad unintended consequences. I am more concerned than ever that increased government financing of health will ultimately lead to fewer consumer choices and will stifle future innovation with tangible economic benefits.

I haven’t received the multiple confusing bills and outrageous line items of detail from the hospital stay yet. Nonetheless, when it comes to getting a quality outcome from an advanced surgical procedure, I prefer the current U.S. health system with all its flaws to the alternative future of less consumer choice and innovation.

Diverse real world problems

pnblog — Mon, 11 Aug 2008 08:00:08 GMT

Last week, we hosted around 20 physicians from one of our Amalga early adopters for a two day, two-way conversation around what the most important challenges in health delivery are and how software can help address them. It was a very instructive conversation -- from which I learned a lot and met some talented, accomplished and interesting individuals.

Part of our objective was to imagine a future where software technology enabled new types of workflows and an extended delivery network beyond the hospital. There was a lot of energy and discussion about the shape of such a future (increase the focus on prevention - inside the hospital and as a core to the delivery network goals). As the discussion went on there was spirited debate about where to start, how to measure and how to pick goals that would really be transformational.

I am not prepared to go into the details of the conversation here -- but there were a few non-proprietary insights for me -- that are worth sharing:

First -- I have a much deeper understanding of the diversity of perspective, understanding and challenges -- of the various specialities and practice groups within a large delivery system. Given this beginning point -- and other factors such as physician model -- I appreciate the need for (and challenge) of leadership to enable change to really happen.

Next the dynamics of an "enterprise" health system seems more like a conglomerate than a traditional product focused enterprise -- even though they are serving a common customer and market. This makes goal setting, prioritization of metrics for performance and resource allocation much harder -- if you want to drive to a common vision.

We started the session listening to Dr. David Pryor from Ascension Health. Pryor described how Ascension set themselves an audacious 5 year goal (zero preventable medical errors) and then went about a series of process improvements to get there. It was fascinating to listen to him describe the steps, the challenges, what worked and most impressively the results they achieved in a relatively short timeframe in multiple different institutions. It truly is a remarkable story -- and given the organizational comments above -- even more impressive. It is great that he was willing to share their best practices openly.

All health delivery organizations face big challenges on multiple fronts. Everyone knows, that quality (outcomes) needs to improve and would reap large economic and social benefits. And clearly -- as Ascension has demonstrated - real progress is possible. In a truly competitive sector -- like banking -- the advancements of the certain organizations would ripple reasonably quickly through the sector (improve or lose share). This dynamic doesn't appear to be at work in the health sector. So it is going to be up to the leaders of our health delivery institutions -- to set audacious goals and drive to achieve them.

Neupert On Health : patient safety

Reflecting on the healthcare system while waiting at the hospital for a loved one

Diverse real world problems