US Healthcare is sick and getting sicker, and while its chaotic complexity suggests to many that it will need to fail big before it can be rebuilt, some simple rules may help to get it back on track. As this the time of year when many of us prepare to send our children on grandchildren off to school in the hopes that they will learn what they need to succeed, I thought we could revisit the lessons of Kindergarten and their application to healthcare. The following list, initially from “ALL I REALLY NEED TO KNOW I LEARNED IN KINDERGARTEN” by Robert Fulghum. has been adapted (read ‘man-handled’) for applicability to US healthcare. You’ll find the original list here: http://www.robertfulghum.com/
- Share everything – In healthcare, this means share ALL the data, all the information, all the acquired wisdom. Interoperable systems are essential. Price transparency is the right side of history. Automated, coordinated, connected systems are essential. Healthcare is too much of a team sport not to share all that we know, so that we can quickly understand what works, what doesn’t, and what it’s all going to cost.
- Play fair – It isn’t fair when decisions are made without a person’s input. It isn’t fair that a patient should bear the risks, the pain, the scars and the costs without having unfettered access to all the relevant information. Shared decision making is part of playing fair in a world where healthcare is meant to happen for patients and with patients, but not to patients.
- Don’t hit people. – We must avoid ‘hitting’ patients with costs they can’t bear, or complications they didn’t know could happen. We should avoid ‘hitting’ clinicians with unsophisticated systems that complicate their lives and distract them from their patients. We need to stop ‘hitting’ innovators with unanticipated or needlessly complicated regulatory hurdles. And we need to work hard to have all of us avoid the ‘hit’ of a financially and logistically unsustainable healthcare system.
- Put things back where you found them. Except for things like an infected appendix or a malignant growth, this continues to make great sense. And as we go about transforming healthcare, we must recognize that wholesale, sweeping changes are easier to envision than execute. While progress requires change those changes that align with / enhance / expedite existing workflows will be easiest to achieve.
- Clean up your own mess – Healthcare is big enough that there are messes everywhere. We should favor local control over central planning. Patients must bear some responsibility for the consequences of their life-style choices that might be reflected in their insurance costs. Hospitals must monitor and manage their own quality metrics. Medical boards need to step up their efforts to spotlight and sanction professional inadequacy. Our federal government must do a better job of limiting inappropriate payments in healthcare. If each of us cleans up after ourselves, things get better quickly.