Bricks and mortar will not heal all that's wrong with healthcare
Originally published by www.hospitalimpact.org - January 24th, 2011
By Thomas Dahlborg
In the movie, "300," a messenger asks King Leonidas for "a simple offering of earth and water." This line has always intrigued me, as "earth and water" in this context resembles "brick and mortar" in the context of our healthcare system.
They represent power, conquest, legacy building, and achievement and yet are not always in line with what is best for the populace. Much time, energy, capital and human resources have been invested in brick and mortar in the healthcare system and much pomp and circumstance and celebration of same. But does a new building represent a true achievement when we are discussing the lives of individuals? Are we focused on the right priorities?
Couldn't those same resources be better spent on addressing the healing model itself?
In the article, "Where are the adaptive leaders in healthcare?" I wrote about a leader at a local community hospital who shared a "success" story about emergency room access.
The challenge at hand included more emergency room (ER) visits, the lack of efficient access to the floors, and high numbers of patients waiting too long for care.
The technical solution was a significant capital investment and building an expanded emergency department at this hospital--the brick and mortar solution.
Now at the end of the day the expanded emergency department might have been the best solution. And yet at no time did anyone truly explore a more adaptive solution by investigating the reasons for the increase in ER visits. No one engaged people both inside and outside of the hospital in the tougher discussions to better understand the root cause of this increased reliance on the ER and to work toward an adaptive solution that focused on decreasing the reliance on the ER itself by improving the health of individuals and the community.
The emergency department was expanded, it was deemed a success, the achievement celebrated. Yet the reliance on the ER has not changed and in fact with the expanded ER the hospital now has a perverse financial incentive to continue to fill the ER rather than to work to decrease the reliance on it.
Now consider the Institute of Medicine's declaration that half of all medicine lacks scientific validity and Dr. John Ioannidis' claim that many clinical studies' conclusions are misleading, exaggerated, or flat-out wrong. Against that backdrop, don't tell me that access to a new building should be our highest priority.
As with the expanded emergency department scenario, shouldn't we be investing more of our energy, and resources on improving the actual healing model than on more bricks and mortar?
Does "brick and mortar" address the lack of reliable, trusted and understood, clinical research and the lack of evidence based treatment protocols? Does "brick and mortar" address the perverse financial incentives in the system (or on the contrary actually contribute greatly to the perversity)?
What are our priorities? Absolutely, new medical office buildings can be impressive works of architecture and construction that are sometimes necessary. But tell me: Is the "system" just as willing to invest in truly fixing the healing model itself, by ensuring physicians and patients alike have easy access to valid, understood, trusted evidence-based clinical research best suited to the individual patient?
Instead of an offering of brick and mortar or earth and water, how about an offering of accessible, valid, understood, and trusted evidence-based clinical research best suited to position the patient for optimal healing?
Let's lose the ego and stop building monuments and legacies at the expense of the health of individuals and the communities. Let's reprioritize and focus our resources on truly fixing the healing model itself and then let's have a real celebration.