The Institute of Medicine’s To Err is Human came out in 2000, estimating that we are killing over 100,000 people a year with the way we practice medicine in the U.S. An updated September, 2013 study in the Journal of Patient Safety reveals that each year preventable adverse events (PAEs) now lead to the death of 210,000-400,000 patients who seek care at a hospital. Those figures would make medical errors the 3rd leading cause of death behind heart disease and cancer, according to Centers for Disease Control and Prevention statistics.
One direction of correction we need to pursue is to get out of our respective silos, and learn to communicate and collaborate. PAE’s harm, waste and deaths are linked to a long history of top-down, abusive relationships among the professions, fighting between doctors and nurses, and various other wars within organizations that oddly tout patient care as their number one priority.
It would seem that “healthcare” would be better achieved if an integrated plan were used. Exit the silos, learn about other disciplines, “cross-pollinate” the information for the best of service delivery, and empower the patient in the process. Sounds like a perfect opportunity for team building and leadership, doesn’t it?
Many studies have shown that people like people-centric, relationship-centered, hands-on disciplines. Since we know that 45 to 85 percent of people with chronic conditions explore one or more forms of “alternative medicine”, then the only way to be patient-centered in healthcare delivery is to include on the teams the practitioners who are experts in those areas.
The problem with this approach to team-building is that business likes the margin on products that are more expensive. Medical business favors sick people over well people, and tertiary care provides the highest margins. So why would they want to extract the most value to health out of a chiropractic adjustment, a therapeutic nutrition consult, an acupuncture treatment, or an hour spent in assisting behavior change?…..especially if the outcome would keep people from needing the high-ticket interventions on which their business model is based. Healthy, empowered people are the antithesis to medicine’s profit centers.
The good news is that the bad news is causing a rumbling about the meaning of health, how individuals might be coached to self-empowerment and well-being, and the transformative cultural shift that has begun to affect healthcare delivery. These outcomes are emerging in policy discussions, federal health law, and organizational practices.
Using the IOM’s Triple Aim of values over profits (better patient experience, enhance population health, and lower per-capita cost), we are entering an era where health systems might actually get paid to keep people healthy! The Affordable Care Act has vastly increased the recognition of licensed integrated practice fields such as acupuncture and chiropractic. There are sections within this law that clearly stipulate non-discrimination in reimbursement, research, health promotion and prevention, work force development, and delivery models such as Patient Centered Medical Homes. All of this is creating a patient-centered, team-based, health-focused, community-oriented future for medicine.
In order to continue the momentum of this movement, we’ll need to learn and practice the roles of leader, “change agent”, advocate, navigator…..any position that puts a premium on communication and collaboration.
To quote John Weeks at the 2013 NYCC commencement address: “Go out and create relationships. Populate that picture of you with at least one of every other type of practitioner or service provider that may at some time be useful to a patient. Create your own circle of care of medical specialists, nurses, other integrative health providers, addiction services, and farmers markets. Stop the cycle of self-inflation and polarization that are bred by silos of education and practice. Continuously invest in these relationships even as you consult and refer unto others as you would have them consult and refer with you”.
The time has come us to put on our big person pants and do things differently. We must grow with the movement in health and medicine toward respecting the whole person, putting the patient at the center, focusing on health, and teaming with others.
Stephanie Frederick, M.Ed., RN is an Integrated Health consultant, independent RN Patient Advocate, and Medical Improv trainer (Improv to Improve Healthcare!). Visit her website for a description of services and contact information @ www.stephaniefrederick.com