Month: April 2022

Guest post by Motient co-founder Dr. Richard Watson

I once had an elderly patient who came to me following complicated heart surgery. She needed a very specialized procedure, and we sent her to a prestigious facility with a renowned medical team. She was from a small, rural farming community, and I wondered how she would react. I asked her what she thought of it all.

“Oh, it was wonderful!” was her response.

“What made it wonderful?” I asked.

“They took such good care of me!” she replied.

I was really glad to hear that, knowing how much effort it took to get her there. I imagine she was impressed by the system, or maybe by the quality of a surgeon. The facility itself had to be impressive.

So, I asked, “What made it so good?”

She said, “Every day in the afternoon, there was this nice woman who would come in and rub my back and talk to me. It was wonderful!.”

Amazing. Literally, hundreds of thousands of dollars had gone into her care. From the early diagnosis to the multiple consultations, to the lab work and the further diagnostics, eventually leading to extensive surgical treatment and rehabilitation. With all of that in the background, the thing that made her care wonderful- high quality in her eyes – was the woman who took the time to rub her back each day and talk to her daily.

And make a human connection.

I wonder who that woman was. Probably not part of the highly trained team whose responsibilities have made them less accessible to the patient. It probably wasn’t even part of this person’s job description. Here’s what it was, was one human being showing compassion for another human being—the essence of high-quality medicine. Human connection is something that can never be replaced or replicated by any technology.

Humanizing the Face of Healthcare  

As we are just now beginning to piece back together our health care system, our understanding of how important the people part of the equation has come forward. The isolation of social distancing, families with their loved ones passing alone, caregivers who are not in any real contact with their patients, a lot of people in healthcare watching their friends and colleagues leave the profession because of the risk and stress, all of which have taken their toll and left us wondering what healthcare will look like now.

The margin in the system as it relates to people has to be addressed. The ability of the hospital environment to expand and contract must be developed and incentivized. Cross-training of staff, training for different staffing levels, stratifying patients more thoughtfully to the varying staffing levels all are needed to maximize the people-to-people interaction during surges. Investing in the education of caregivers and career tracks for nurses that retain our most important part of healthcare is essential.

Creating an environment that allows mandates and excessive workloads to be the norm will disincentivize care teams and career nurses. The mobility of staff continues to be a challenge, but more so for future surges. The balance between pay and commitment must be realized. As salaries catch up, I think this will be less of an issue.

Turning Data into Useful Information & Better Decisions  

All these discussions need to be data-driven. Understanding the current stress on a health ecosystem is essential for making calculated, proactive, and justified decisions about patient care. Data-driven decisions offer a proactive way to identify the moment patient movements are needed to keep the system moving and intact.

People who run facilities need to understand their own capabilities and strengths. Patients need to be matched with the proper resources needed to care for them. Consider the regional need to understand capacity and capability and broadly understand how patients move within the system to utilize appropriate resources fully. The ability to make decisions based on data allows the ecosystem to expand and contract. It gives confidence and expectation to the people doing the hard work of caring for others.

It All Comes to This…

No doubt, each of us will face a moment where we need someone to “rub our back.” It is a constant reminder that simple acts of kindness, even in the midst of the behemoth that health care has become, are what makes our lives rich.

Human beings caring for other human beings—that’s the essence of human connection in healthcare.

Guest post by Motient co-founder Dr. Richard Watson

Olympic legend Shaun White gave his final snowboarding farewell at the 2022 Beijing Olympics. Despite winning no medals this year, the three-time gold medalist leaves a legacy behind. Still, it is evident how much teammates admire him. His casual, calm, and nice-guy approach to the sport and life itself made him a real favorite to follow. It was palpable to watch as White walked among other boarders, many of whom he has heavily influenced. As for White’s next chapter, it seems to include his snowboard and lifestyle apparel company, Whitespace. Even with my very limited marketing understanding, it is not lost on me — a guy named White, who loves snow, and the creative space outside the lines—it’s very clever!

Growing up with pencils and our trusted Big Chief tablet paper and no white space — where the lines went clear to the edge of the paper and so did our writing—that break from regimented, constrained borders is compelling. It brings to mind a book I remember from the 90s, entitled “Margin,” written by Richard Swenson. Margin, to me, has always signified a difference: a margin of victory, a margin of risk, or a profit margin.

Life is Lived Beyond the Lines

But that was not where Swenson was going with the concept. If our lives were a thin sheet of paper, a significant area would be devoted to the responsibilities of work, family, and the cares of the world. Only a margin would represent that part of our lives outside of the regimented. Those areas of creativity, contemplation, and rejuvenation are places where our brains find the most freedom.

How easy it is to “drag and drop” our margins right to the edge, constraining us to that which is within the lines. But isn’t that exactly what health care has become?

While Healthcare is Trapped Inside the Lines

If healthcare ecosystems were a sheet of paper, the incentives have produced a day-to-day behavior with very little outside of the hearing. Lower inventories, single-source supply chains, and conscripted functionality with little or no flexibility for change have all locked us into a box. The system as a whole has become so ingrained with the very concrete processes that disincentivize any freedom to deal with variation.

It’s as if there wouldn’t be a moment outside of the two standard deviations from the mean. The HHS’s Medical Capacity and Capability Handbook is certainly comprehensive if it is nothing else. Layers on layers of oversight and committees, multiple layers of bureaucracy, and micromanagement. The National Stockpile Plan is similar in its comprehensive nature, but at the same time, allows only three days of medical supplies. Not to mention that the lack of replenishment has pilfered every reserve. It is no wonder that the system has been dangerously lean.

We Have a Chance to Reflect, Re-Evaluate, and Rewrite — Outside the Lines

Health care will soon be emerging from the current wave of the pandemic. It will hopefully be a time of reflection and revaluation.

1. Central versus local roles should be examined. With geographic disease variability and seasonal variations taken into account, distinct lines between primary decision and control and that of a supporting function are critical. A one size fits all is insufficient and heavy-handed. Networks for information, supplies, and technology become essential central functions.
   Strengthening the public health system is crucial. To become national healthcare’s real infrastructure and resource, the local public health system has to be the leader in resources, day-to-day monitoring, and system preparation.
2. Incentivizing local and regional supply chain and sourcing. Having these functions locally ensures adequate means that fit the need. Incentives need to be in place to solidify the idea that margin in the system is not waste but is essential to the ability to expand and contract with the need.
3. Bio-surveillance is critical to being in front of these global events. Appropriate recognition of the cost of not embracing vigilance in this area is obvious. In that vein, the FDA has a responsibility for emergent pathways for vaccine and drug development. These need to gain the public trust to assure that pharmaceuticals are available in the appropriate quality and quantity and in a safe manner.

A Healthcare System with Room to Grow  

The lack of white space in healthcare has been glaringly obvious over the last couple of years. The lack of local and regional control has constrained the actual activity of caring for the people around us. As the balance shifts back to the level of care delivery, the system will be free to meet the demands of any challenge.