Saving American health care from a disaster worse than Covid-19
For decades, the American medical system has suffered from access and quality issues, outdated technologies and unaffordable prices. And, as I wrote last month, this failing system now stands in the way of the perfect storm – a confluence of three mega forces:
- Health care inflation. Medical costs will rise at double-digit rates from 2023, experts say. If these estimates hold, total health spending will double in just seven years, from $4 trillion to over $8 trillion.
- The shortage of nurses. A recent study indicates that 90% of nurses plan to leave the profession in the next year. Nurses report unrealistic job demands, violent patients and lack of support as reasons for quitting.
- The burnout crisis. Nearly half of physicians feel overwhelmed and underappreciated. Many hospital physicians (anaesthesiologists, emergency physicians and surgical specialists) have turned to private equity firms for greater bargaining power.
Quick, to the hospital!
These three mega forces will negatively impact all aspects of the healthcare system, but no area will be hit harder than our nation’s 6,000 hospitals, which employ nearly 6 million people, provide care to 30 million people. ‘Americans every year and account for more than a third. of all medical expenses.
Already, 900 US hospitals are at financial risk of closure, threatening to leave millions of patients without access to life-saving medical care.
These developments pose a serious public health risk and will prove far deadlier than Covid-19 unless our country takes urgent action. Like a Category 5 hurricane on the horizon, there is no stopping the storm. But hospital administrators can limit the damage and buy the time our nation needs to repair the broken foundations of health care.
Solve a Cornelian health dilemma
Faced with the long list of pressing issues, most hospital and health system leaders feel trapped between two bad options: raise salaries, hope to keep doctors and nurses, and risk going bankrupt as expenses are skyrocketing. Or increase workplace demands and see people quit, leaving the hospital without enough doctors, nurses and staff to meet patient needs.
The pool of proposed solutions is deep and wide.
Extending health insurance coverage would increase access (and perhaps affordability) to medical care. Moving physician compensation from the current “fee-for-service” methodology to a value-based model would incentivize caregivers to keep people healthier and avoid the complications of chronic disease. Replacing today’s clunky health record systems would reduce frustrations for doctors and nurses. Tackling the “social determinants of health,” which contribute to more than 50% of medical outcomes, would breathe new life into our country.
These ideas and others like them are excellent and essential for the future.
Unfortunately, all of this would take a decade or more to implement. We do not have much time. The mega forces will wreak havoc within two years.
Where to start?
For most of the hospital’s history, doctors could do little for patients other than provide basic medications and supportive therapy. These limitations have kept the cost of care low and the task of providing it relatively unconstrained.
In contrast, today’s hospitals are bustling with activity day and night as doctors deliver ever more complex treatments at ever higher prices. Yet, despite all that has changed, most hospitals retain the same operating model they used in the past. As a result, medical care in these facilities is inefficient, chaotic and unsatisfactory for both clinicians and patients.
And that’s why improving the delivery of care in American hospitals is where the solution must begin. Here are just three opportunities to increase access, reduce costs, and improve job satisfaction.
1. Invest in people
Surgeons perform most operations with impeccable speed and precision. Gallbladder removal and hernia repair, for example, can be done in 45 minutes. But when the operation is over, inefficiency takes over.
The nurse transports the patient to the recovery room, then locates the instruments needed for the next case and, upon returning, often finds that the housekeeper has just started cleaning the operating room. A 45-minute delay between 45-minute cases is common. These delays frustrate the entire operating team and create surgical backlogs.
Asked how to improve hospital operations, nurses in a recent survey called for (1) streamlined processes and (2) better communication and coordination. Doctors, meanwhile, cite “long hours” and “lack of control” as two of their top complaints.
One solution to address these frustrations is to add an operating room technician to the surgical team.
The person’s job is to support clinicians and expedite time between cases. Thus, while the surgeon is finishing a case, the technician ensures that the surgical instruments are available and ready for the next case. And after the first surgery, this person would help transport the patient to the recovery area and bring the next patient from the pre-operative area. And if/when housekeeping is delayed, the technician would begin cleaning the room to minimize turnaround time.
For a hospital CEO or CFO, hiring another person seems financially unwise. But it’s far costlier and more costly to have four clinicians – a circulation nurse, an OR nurse, an anesthetist and a surgeon – waiting and frustrated.
Reducing turnaround time from 45 minutes to 20 minutes would allow surgical teams to treat seven cases a day instead of five. This 40% increase in productivity would reduce hospital costs and increase access to operating rooms. It would also improve everyone’s job satisfaction, as healthcare professions are mission-driven and would much rather solve patient problems than sit idly by.
This same approach – investing in people to reduce costs and increase access – can be applied in radiology and procedure rooms where patients undergo colonoscopies and other procedures that often take less time than refill. subsequent rooms.
2. Eliminate 10,000 steps
A nurse recently told me that she takes over 10,000 steps a day at work. I was not surprised. Most nurses are assigned to patients whose rooms are at opposite ends of a long hallway, sometimes separated by half the length of a football field.
It takes nearly two hours to cover 10,000 steps. And that’s two hours a day when nurses aren’t providing bedside care. So why not assign each nurse to care for patients in adjoining rooms rather than those scattered around the inpatient unit?
Similarly, ER doctors are usually assigned to patients based on their order of arrival rather than the part of the ER where they will receive their care. It is inefficient and dangerous. Hospitals could eliminate wasted time by assigning an emergency doctor to the most seriously ill patients in one part of the ER while a second doctor treats minor issues like sprains and lacerations in another.
Not only would this lead to more efficient care, but it would also save more lives since a doctor could keep their eyes on high-risk patients at all times. Of course, this approach would need to be adjusted based on the size of the ER and the physicians present, but the principle of minimizing steps and maximizing hands-on medical care would improve efficiency and quality in all but the smallest ERs. .
3. Develop team excellence
The more medical teams work together and deal with the same types of problems, the more skills they gain, the more efficient they become, and the better their results.
But even in the 50% of US hospitals that belong to a “health system” (with multiple facilities and specialties, all under a centralized management team), there is a huge duplication of clinical services.
For example, in one community in Silicon Valley, three hospitals offer virtually identical services (cardiac surgery, neurosurgery, cancer care). And because of their proximity, none have sufficient patient volume in any given area to achieve clinical excellence. But if each hospital focused on one clinical service, all three could become ‘centres of excellence’.
At The Permanente Medical Group, we have applied this concept to esophageal cancer surgery. This operation often leads to complications due to the weak wall of the esophagus and the stress placed on the repair. But by creating a small group of doctors and nurses to perform these highly specialized operations, the complication rate dropped to near zero, with the average length of stay for a patient cut in half.
The doctors and nurses working in this environment were some of the happiest I have ever seen. Being part of a winning team boosts job satisfaction, even when treating more patients.
Saving American Health Care from Disaster
The three mega forces in healthcare have the power to drive up costs, drive doctors and nurses out of the profession, and close hundreds of hospitals. Making these local operational improvements would help mitigate future issues until system-wide solutions are implemented. But they will demand that hospital administrators sit down, listen and work with the people who provide medical care.
Those who do will undoubtedly discover dozens of other solutions to save time, reduce waste, improve efficiency and satisfy professionals that can be implemented quickly. But they must hurry. Hurry up.