Physician heal thyself. Other business sectors have been looking at employee engagement for decades, but in health care we’ve just begun to peek behind the curtain. The nature of the most effectively delivered health care is not transactional, it’s driven by a relationship—one that demands presence and trust, resilience and adaptability, and compassion and understanding. Yet these characteristics are difficult for today’s providers to embrace if their own, more basic human needs are not being met. Burnout and lack of engagement have become the leading indicators of misery in physician practices.
But what if physician satisfaction was as important to health system administrators, as patient satisfaction was to providers? What if our providers, level of joy in their work became a standard metric for measuring the quality of a health system?
As a country, we’ve been talking about moving from volume to value for a long time. Yet by almost any measure, in particular the 18 percent of GDP we currently spend on health care, our efforts have been decidedly underwhelming. Most of us are still trying to have it both ways. We encourage providers to move away from a fee-for-service model and embrace value and innovative care delivery systems. At the same time we’re still measuring their performance in RVUs. If we want to move away from this schizophrenic organizational perspective, the fundamental decision we need to make is this: Are we’re committed to improving value or not? If we are, then we need to prepare for difficult conversations with providers, payers, and patients. There’s no way around it. Transforming the financial landscape of health care will require that we radically realign the culture so that people, including patients, are working on the same team with a shared vision. And that will require visionary leadership.
Just as we think about the possibility of coming together to pilot a progressive payment model, can we move away from our piecemeal approach and work with one another to lead the cultural change that shifting from volume to value requires?
No one likes to be admitted to a hospital and even fewer patients like to stay there longer than they need to. Try as health systems might to avoid them, the hospital is where unnecessary complications happen most—unfamiliar environments, sleep disruptions, lack of proximity to family and other support systems often lead to more problems for patients than the ailment that brought them in. Furthermore, many hospitals are operating at critical census displacing open beds for populations of patients who need them. Comparatively a night in the hospital is one of the single-most expensive stays that people can spend. And some health systems are testing the question of whether certain patients can be just as well cared for, with hospital-level support, in more familiar environments. Technology is beginning to allow it, now payment models must begin to follow suit.
What if health systems could manage acuity differently? What if we could build support structures and align payment models to take better care of qualified patients in their own homes?
It’s no secret that the U.S. health care system has organized itself around silos: departments, divisions, specialties and sub-specialties. And though this specialization has been exactly what’s propelled some of the greatest breakthroughs in science and medicine, it’s also precisely what may be holding us back. Disease, let alone a person’s overall health, pays no attention to our institutional org charts, or the myopic way we’ve been measuring outcomes. Is cancer care successful, after all, if you need a feeding tube? Is a knee replacement successful if you can’t ride a bike without pain? Reorganizing around medical conditions, and rethinking outcomes, is just one step toward a more patient-centered, less provider-centric system. The final destination is preventing the conditions in the first place.
What if we disrupted our deeply entrenched thinking, broke down these traditional silos and organized our collective efforts around solving one particularly troublesome disease? Diabetes, obesity, the opioid epidemic, heart failure, mental health? Think about the progress we might make, the ways of working we would discover, and the good we could do.
The brave new world of data has health care—along with every other sector—spinning. Petabytes of incredibly promising data from EHRs, genetic sequencing, wearables, and countless other sources, keep coming at us far ahead of our ability to make them useful. Yet without a grand playbook, or anyone in charge, the mind-blowing potential of big data, predictive analytics, artificial intelligence and the like can seem crushing, especially after the painful meaningful use journey. Keeping people excited and hopeful about data may be the first challenge.
But if we want to get out ahead of our health, data is our greatest tool. It will allow us to switch from a reactive system to a proactive system, to simultaneously standardize care and customize it. Creating an integrated approach and data infrastructure may require our biggest, broadest, most collaborative thinking yet. We’ll need to broaden our view about what information is relevant to health (think social determinants), insist that data flows freely, and keep the faith that together we can figure this out.
Many a provider has thrown up his or her hands after a patient interaction and thought: I can’t care more about your health than you do. It’s a fact of life that patients often don’t take medicines, follow protocols, do therapy, or show up for appointments. But here’s the question: If we know that human behavior plays a critical role in a person’s overall health, why have we not devoted more resources or created a better system to engage patients?
What if we, as provider and systems, joined forces with patients to make it easier for them to live healthier lives? We could partner with elementary and high schools to develop health literacy curriculums that would include practical, everyday skills like how to read labels in a grocery store. We could find ways to leverage all of the social media platforms to engage friends and families and communities to make living healthy fun and social? Not our role? Maybe we should think again.
If our social, economic and physical environments—combined with our physical and genetic profiles—determine our health status, then how far should health systems reach to deliver care? As some of the largest employers in our states, health care systems have the opportunity to expand the scope of "health care" to improve the communities around them. Yet health systems can't do it alone. Current incentives and distribution of resources require an expansion of partnerships—capturing savings forged from hospital admissions and channeling those to social programs as well as engaging social constituencies to invest in health systems dedicated to the health of their mutual populations.
Can we build a conceptual framework to map the intersection of health care and the social determinants that feed the need for their services?