During this year I had unusual several encounters with a number of healthcare providers, sometimes as a patient, and others as a companion or caregiver, both in inpatient and ambulatory settings. This experience has lead me to personally reach a conclusion that I’ve realized deeply: today’s healthcare is very dysfunctional and full of waste! This is not news for many of providers and consumers of healthcare, and definitely has been the case for decades, but perhaps the blessing (or curse in this care) of learning more about lean, system thinking, continuous improvement..etc, has made the picture so crystal clear and easy to spot, compared to the untrained eye.
The irony lies in that everyone claims they are providing the best quality, most compassionate and patient-centered. You could hardly find a healthcare facility without these as strategic goals, values, and slogans everywhere, while in the bitter fact, most of them are merely average. Another irony is that many for-profit organization assume they are making a lot of profit based on the financial reports, but if you look deeper, they are wasting as much money down the drain. Then we wonder why healthcare costs keep rising, and why quality and safety are not getting any better, at least in the patient’s eye.
Miscommunication:
No two people disagree that communication is one of the most important requirements of safe and good healthcare, and everyone preaches about that during meetings and conferences. So, we try to standardize it in a very restrictive manner, or purchase high-end automated information systems. However, when it comes to real daily work, miscommunication is very common, and at many instances, highly risky.
One can easily notice the number of repeatedly asked questions by different healthcare professionals at any care setting, whether outpatient, inpatient or in between. It makes one wonder if there is any dialogue actually going on between receptionists and nurses, nurses and doctors, doctors and other doctors, you name it, and whether they really do work as a team like all the nice group photos posted on the walls or websites. This gap will eventually lead to waste in time, effort, and the cost of sophisticated system, or at least paperwork, let alone patient dissatisfaction. Working in silos is an issue in healthcare that improvement experts talk about all the time, but is still very common and evident.
There are several factors that play part in this. The first in my opinion has nothing to do with the intentions or even the awareness of the providers about the importance of good communication, but with how the clinical care processes are designed in the first place. Most of the care planning is individualized, the information gathered about a patient condition are documented, sometimes overly, but not shared in real-time, and everyone know hot to navigate and fill fields on the computer, but not actually reads. The other factor is more cultural.
The hierarchical relationship between healthcare professionals where the physician is still an authoritative figure that don’t communicate with others readily and openly, and by that I mean 2-way communication. I’ve seen many cases where this disconnect lead to patient harm and sometimes death.
to be continued...
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