Is It Possible That All Healthcare Needs to Know We All Learned In Kindergarten?


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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.
  • 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.
  • Don’t take things that aren’t yours. We must stop stealing money from families for tests and treatments that do not work, or work less well than less expensive alternatives.  We must stop stealing time from clinicians by imposing regulations and requirements that add to their administrative burden without aiding them in the care of their patients, or asking them to perform repetitive functions or complex tasks better left to smart devices). And we must stop stealing opportunity from all, and refuse to tolerate a status quo that has a disproportionate share of our national budget being spent on a sub-par healthcare system.
  • Say you’re sorry when you hurt somebody. Lets admit that no part of the healthcare enterprise is perfect. Clinicians make mistakes, technology has inherent limitations, drugs have side-effects. We must acknowledge that risk is the price we pay for the innovation we desperately need. Defensive medicine, unwarranted malpractice claims, and expensive and lengthy product liability suits can all add friction to a process already struggling under its own weight.  While those harmed must be appropriately compensated, well-intentioned imperfection must be tolerated and not punished to the point where we frustrate needed progress.
  • Flush. – Oh, the things we should flush. Lets flush things like late-night advertisements (I-800-SUE THEM) that appeal to the angels of lessor mercies and exploit our tort system to further burden our healthcare system.  Lets flush the distortion resultant from a 24-hour news cycle and Catastrophic News Networks that so highlight tragedy and failure that we have a stilted view of our healthcare successes. Lets flush the amazing pricing variation for similar services in slightly different locations or practice settings, and lets flush the waste, fraud and abuse that contributes a full third of our already swollen and inflamed healthcare spending.
  • Warm cookies and cold milk are good for you.  Comfort foods are their own incentives, and a national epidemic of diabesity proves that incentives work.  In healthcare, shouldn’t we align incentives with the desired behavior and make those things that are good also easy. Let’s use comparative effectiveness results and pursue value-based insurance design so that those things (tests, treatments) that are truly good for you are also financially attractive for you to use/receive.
  • Take a nap every afternoon.  A nap is still good advice.  Lots of studies point to the value of good sleep (for everyone).
  • When you go out in the world, watch out for traffic, hold hands and stick together.  While healthcare is a team sport, lets be clear that personal responsibility is essential, as it is personal choices that determine billions of dollars of healthcare spending. And shouldn’t we act more like a team and advance care coordination to reduce fragmentation and duplication of services whenever possible?  And as we look out for risky settings, lets be much more clear that simply being in a hospital is a very risky proposition.
  • Be aware of wonder. Remember the little seed in the Styrofoam cup: the roots go down and the plant goes up and nobody really knows how or why, but we are all like that. Medicine is a cross between and art and a fledgling science.  Lets be clear that we know much less than we should, and that much of what we believe we “know” turns out to be wrong.  Lets always appropriately caveat our guidance with our uncertainty, admit that our understanding is substantially incomplete, and be willing to learn from each new encounter.
  • Goldfish and hamsters and white mice and even the little seed in the Styrofoam cup – they all die. So do we.  Lets embrace the undeniable truth that death is not a medical defeat to be avoided at all costs, but an intensely personal closure that deserves thoughtful preparation with complete respect for patient and family values.
  • And then remember the Dick-and-Jane books and the first word you learned – the biggest word of all – LOOK.  Lets be aware that healthcare is on a journey, that we are all participants, and each has something to add to the story.  If we keep our eyes open, share what we know, take personal responsibility, play fair, and use hard-won lessons learned from other industries and in other countries, we can doubtlessly transform US healthcare delivery to a sustainable system of patient-centered excellence that we all want and deserve..

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  3. Insurance is one of the most humane inventions of mankind, if used properly.
    Imagine the idea of a group helping an individual to be made whole.
    Imagine this cooperation, in which all parties win – the providers, the insurers, and the insureds – over the short term, and especially the long term.
    Imagine health insurance premiums that reduce over time.
    Imagine policyholders sticking with their insurer, instead of an insurer trying to replace its clientele every 3-5 years.
    Imagine using common sense, the kind of horse sense we knew of in kindergarten.
    Don Levit