In Atrómitos’ recent monthly newsletter, I asked a simple question, but one which, I don’t think anyone has a good answer to. When it comes to healthcare, what is quality? What do we mean when we say, “good quality care?” The same day I wrote this, an AP News article, “Americans Give Health Care System a Failing Mark,” appeared in my news feed. This is on the heels of my struggle to find my son new health care providers so he can get his very immediate needs met – waiting lists and appointments scheduled 2 months out is our current reality. So, getting an answer to this question is not only relevant professionally; it is personal.
As someone who has spent all my professional life working to improve the healthcare system, I acknowledge that I feel a bit jaded and disgruntled these days. And I am not alone: so are our health care providers. More than half of the healthcare professionals in the US report that they are currently experiencing burnout. Let’s be clear, burnout isn’t just stress or dissatisfaction. It is a persistent state of emotional, physical and mental exhaustion brought on by excessive and prolonged stress. Talking with many of these providers, it isn’t just the stress and demands of the job. It is also the sense of limitation in the ability to make the kind of impact that led them to health professions in the first place. Burnout can be crippling.
Think about that. More than half of the people whose job is to ensure our health and wellbeing have reached a point of total exhaustion, where they feel that what they do is a total waste of energy, and that everything is bad.
No wonder I can’t find health care providers for my son. Many are leaving their professions altogether, while others are significantly reducing their work time.
A key driver of this burnout is the use of electronic health records (EHRs). EHRs are a fundamental component in our system of quality data collection and reporting.
And so, we come back to my question: what is good quality, and how do we know when it is present?We currently measure many things. So. Many. Things. And we measure them in so many different places (again and again). There is a lot of data out there, but are these data points really the ones that we, as patients and consumers really care about? Are they the most impactful to the outcomes that we are looking for from our healthcare systems (#measurewhatmatters), or are these many, many technical measures a shortcut to continue to address (or rather, delay) change through repetition of what we know? Is it a case of doubling down on the familiar and the technical when confronted with an increasingly untenable status quo, where transformative change is necessary?
And let there be no mistake, when it comes to healthcare, we are at a point where transformative change is urgently needed, a point underscored recently by U.S. Surgeon General, Dr. Vivek Murthy. Some might call the doubling down on repeated technical tweaks (and more technical measures) a “rearranging deck chairs” on the Titanic. Others, including the health writer, Kim Bellard, put it as the human instinct to look to an additive solution (“To add is expected to Subtract Design”). What I know is this: Like everywhere else – public schools, employee reviews, etc. – people will prioritize what is measured, and what they are judged on. To get to fundamental change, we have to shift what we measure, and what we judge our healthcare system on. And maybe (just maybe) the multiplying measures that we cling to are getting in the way of what we really care about. To quote my colleague Tina Simpson, it is a good principle in life that, when in doubt or when there is too much complexity, return to the core and seek the simple. Or, to borrow a phrase, “do simple better.”
I thought about this question after having hung up with another health care provider’s administrator, looking for an opening to address my son’s immediate needs met. I thought about what the measures and the outcomes that really mattered to me. I cared about my son having access to a competent provider in a timely manner. That first step of access –to overbooked, overburdened providers in my area – to have an appointment that wasn’t two months out, was what I cared about most immediately. And with all the resources at my disposal, including being ready to pay cash in hand for that appointment, as well as my own knowledge of the healthcare system as a professional, I have not been able to secure that.
We need to do simple better; to return to first steps and first principles. Because while we have a lot of activity around Quality measuring, we haven’t had much success in meeting our goal of consistently and equitably providing the right care, at the right time for all in our communities.
It is our practice to look to policymakers and to those within the healthcare system – providers and administrators – to identify and implement the solution to these problems. This hasn’t worked well for us. In fact, it’s what got us in this quagmire to begin with. We all know that real, transformative change (not additive, iterative, or incremental change) comes from external forces – not internal. It is up to consumers – patients – to reflect upon what we expect from our healthcare system and demand reform in line with those expectations.
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