Guest post by Motient co-founder Dr. Richard Watson
Growing up in the rural Midwest, I would never consider myself a “farm boy.” My parents were both PhDs, and although we had cattle and horses, hauled hay, and planted milo, I don’t think we would have qualified to be in the same class as the revered families that know what it’s like to depend on a series of variables that no one has control of to make a livelihood.
Understanding moment-by-moment the importance of coexisting with the land and the weather, respecting what you know and don’t know, and being humbled at every turn either molds character or destroys it. The whole idea seems merciless to me, but some of the most important figures in my life came out of that crucible. I have so many memories of those days, mostly happy, some wonderful, some sad, but many that are hilarious and representative of the chaos that humans, animals, and land can find themselves in.
I would sometimes work for the farmer who lived down the road from us and enjoyed seeing a pro at work and trying to get my head around how someone would choose that life. Harvest was the best in my mind: The moment when all the other moments would come together, and the beauty of the fields gave up their hard worked-for crop. Silage was by far the most mysterious to me. Cutting corn while still green and then blowing it into cylindrical towers where it would be left to ferment and become rich nutrition for livestock. Silos themselves are amazing: These monoliths of the plains are the icons of hard work. They are formidable to withstand the elements and their intended purpose.
The View from Inside a Silo
I find it interesting that in healthcare, we refer to the silos of care. Certainly, this is true of patient movement. Sending facilities, receiving facilities, and transport services all have formidable foundations, and the infrastructure is an almost impermeable structure that seems limited by its own occupied geography. Standing in a silo, the walls are readily apparent. You become acutely aware of the limitations of your own space. When you do look out, the only view is straight up and is limited to a very small picture of the outside world. That limitation gives minimal data as to what the outside is really like. Healthcare mirrors this in the way we develop space in our own confined geography, but the view out is very limited. Amazingly, you can never see another silo from inside of your silo.
Building Fresh & New on a Strong, Clean Foundation
One of my jobs before harvest would be to clean out the silo. At the beginning of each harvest season, there would be silage leftover from the previous year. I would crawl in through one of the openings and begin shoveling the remains out. At first, it was the sweet fragrance of the fermenting silage, but it would quickly deteriorate into a stinky, wet, rotten mess! Much like health care, there is little interest and getting rid of the old and the rotten.
We continue to keep that covered.
Healthy Harvests — and Systems — Require Regular Maintenance
The future of health care depends on the constant, consistent, calculated dismantling of our silos. We have readily learned that we can’t have a never-ending supply of healthcare resources. We’re only beginning to experience the wave of the aging boomer population and the financial challenges ahead. The decreasing rural population and the regionalization of more and more services will require us to match patients more thoughtfully with medical services. Forming links to telehealth resources will help maintain transport and referral capacity and will be essential. Intentional, proactive communication between sending facilities, receivers, and transporters, will be the first step in understanding the needs and obstacles of the individual institutions. Forming these coalitions and including payers will actually give financial teeth to the decisions made.
The most important realization for health care is that we all have a place in this world. Fears that drive protectionist activity are limited page progress and unnecessarily unhelpful with what we know to be the future.
It is time to shovel out the old and prepare for a new crop.