Home from the hospital. I'm still dealing with the remnants of the mystery infection that clobbered me. But having escaped, mostly in one piece, I thought it was time for some reflection as well. First, you spend much more time than you'd like sitting and sweating in your bendy bed -- sleeping for any reasonable amount of time apparently being unimportant in the scheme of things. And, because there really isn't all that much else to do, I kept thinking about process improvements, systemic changes and - in our crazy data-driven lives - what should be the realistic expectations of patients in terms of learning, in context and in real-time, about the plans for and progress of their own care.
Everyone you speak to inside and outside the hospital is an expert in health care-- no qualifications, training or experience necessary-- but I'd say a good place to start is with the idea that the system should fit people, not the other way around. If there's a theme song for healthcare today, it's got to be based on Dire Straits' song Money for Nothing ("Now, that ain't workin', that's the way you do it; money for nothin' and your chicks for free." ) because in the hospital I heard this refrain day after day: "that's the way we do it." And you don't get anything for nothin'.
That said, you can't get out of any hospital these days - however long your stay - without being extremely grateful for the people who cared for you 24/7 and the quality of the care you received. You quickly learn two important things when you're bed-bound and relatively helpless.
First, you quickly come to appreciate the critical importance of "friends in low places." The physicians may think they're in charge, but the real lifesavers are the everyday people -- nurses, techs, dietitians, and especially the cleaning people, who make or break your experience.
And second, you learn about pride. There are NO horrible, boring or even routine jobs in any business -- it's all up to the individual and what he or she makes of the job. Any job can be important, creative and challenging if you put your heart and mind into it; conversely, even the most creative endeavors can become routine if you don't invest in the process and just walk through the days in an uncritical stupor. Every hospital staff person I encountered was proud of their role in my care. They understood that they weren't in the food prep or blood draw or cleaning business. They were an essential and important part of the only real thing that matters in medicine: the caring and connection business. They weren't mindless or interchangeable cogs in some stupid fix-'em factory; they were individuals whose job it was to demonstrate to me and convince me that they were there to help me get better and get out. And, they did a great job. It's never the soldiers who screw things up and lose the war; it's always the generals.
I'm convinced that the technical precision, equipment and instruments, and the level of the medicine being practiced today (even in teaching hospitals) is as high as it's ever been and that's the very good news. But from the standpoint of the patient, that's only half the story. The ways of addressing the patients' mental and emotional issues and needs-- for connection, communication and information--are still as messed up as ever. That's a big problem that clearly remains unresolved. It's a people problem -- and the people who are the problem are the physicians. Whether they're too busy, too tired, too stressed, too overly-trained to be utterly un-empathetic, or whatever it is, they suck at serving the interpersonal and informational needs of the patients. And, because they're on a crazy merry-go-round of rotations that assure that you couldn't possibly see the same docs for more than a few minutes every few days, if you're lucky, the prospect that you'll make a real connection with any of them is next to zero.
These issues aren't that different from many of the concerns that every business faces around the critical need to be customer-centric. But what was very striking in my own hospital experience was that regardless of how many questionnaires and inquiries are incorporated into reviews and discharge procedures, if you're consistently asking the wrong questions or focused on immaterial metrics, you're not going to learn anything of value. The administrators who run these massive hospitals don't have a clue about how to ask the right questions. What you measure and pay attention to are what define and determine the success of your business. Feel-good focus groups, useless data collection, made-up metrics and ratings that don't address core concerns are a complete waste of time.
I had a volunteer conduct a questionnaire about my relationship with one of the main docs allegedly "responsible" for my care. He had to show me a picture of the doctor, who I barely recognized, and had maybe seen once in my entire visit for a couple of minutes. As he started asking about whether the physician and I had "good" substantial conversations about my questions and concerns, I actually started laughing. This was a complete waste of time. First, because the one thing that is abundantly clear is that no one at the hospital does anything by themselves - there are always 3 or 4 people in every meeting, visit, conversation, etc. So, trying to evaluate my engagement and involvement with a single doc was a joke. And second, I had no idea what this doc's role was even supposed to be in my overall care so I couldn't really address anything substantive anyway. It was an inquiry straight out of Alice in Wonderland.
There are no easy or quick answers because the health care system is completely broken (albeit still better than anywhere else in the world), but here are a few things that anyone with the slightest interest in the experiences of their patients should address immediately.
(1) Antibiotics Shouldn't Be A là carte
I'm the patient. What do I know? There's a drug to prevent blood clots that might arise from being bedridden. Seems to make sense. But here's the thing, the schedule said to administer the drug 3 times a day, but I was asked by some very considerate folks from time to time if I wanted the shots. Would this instill a great deal of confidence in you? How the heck do I know whether I should have the shot or not? Healthcare consumers don't want more choices and alternatives - we want answers and expertise.
(2) The Patient Shouldn't be the Last to Know
I fasted overnight several nights for no reason. Tests that were set for the following days, which required no food or drink for 8 hours prior, simply disappeared from the schedule. No explanation. No reasons given. Just gone. Emergencies, illnesses and changes in a hospital are all inevitable and readily explicable if someone cares enough to do the patients the courtesy of telling them what's happening and why. Ignorance is curable; indifference is what kills the experience and ultimately the culture.
(3) The Patient is Entitled to A Consistent Single Point of Contact
I had rotating teams from cardiology, infectious diseases, internal medicine (maybe - not sure), and probably some others, and they would stop by from time to time to update me on the narrow and obscure aspects of their particular areas of investigation. But they had no apparent information or connection to the activities of any of the other teams. There was NO ONE who appeared daily to actually tell me what was going on with my care and progress (or lack thereof). And it's not even clear who that person is supposed to be.
If you think that problem-solving and way-finding for inbound inquiring customers in your own business is easy, you're sadly mistaken and you should spend a little time calling your business and trying to navigate your website. Nobody does it well - but when you're also stuck in a bed, the data deficiencies are even more obvious.
(4) "Rounds" Ought to be in the Room, not the Hall
I learned what little I knew about my prognosis by eavesdropping on the morning briefings (rounds), which were being held outside my room, where someone who seemed to know something about where things stood would brief the rest of a group of other doctors about my condition. It would have been so nice and helpful had they taken the time to share the updates with me as well. Frankly, the guy in the room next door (who always had his door open) probably got better info about my treatment than I did simply because they stood right in front of his door. HIPPA Hooray. There's a sign that says I can get help on the phone in a zillion different languages, but, of course, I have no idea who to call.
Are answers easier to come by in your business?
(5) It's Harder to Pee in Starbucks
It appears to me that any mope -- completely devoted or utterly deranged -- can walk into the hospital, hop onto the elevators, ride to some floor and wander into any patient's room without being questioned or challenged. It's honestly much harder to get into the restrooms at Starbucks. No visitors' passes required, no surgical masks offered, no invitations or permissions necessary, no limits on guests -- drop on in whenever you please. Just like Bakers Square, come for the meal, stay for the pie, no extra charge for the MRSA.
No one expects overnight cures and simple solutions - but if you're not completely customer-centric today and fanatically focused on their experience and expectations, you're nothing.