Let’s Stop Looking Backward at Our Healthcare Mistakes

News

Why does it feel like we’re always doing things backward?

Over and over again as we try to address the many broken parts of our fractured healthcare system, it feels like we are waiting until something goes wrong, and only then do we devote massive resources to cobble together a fix in the best way we can. This happens in many different contexts: when we have a bad patient outcome, a quality improvement case, a patient complaint, or a safety issue, we then mobilize teams to do a root cause analysis to try and figure out where things went so terribly wrong.

Whenever we do these, it feels like we are slathering solutions on top of an unstable infrastructure, with the potential for things to come crumbling down again the minute we stop paying attention and shoring up this particular crack in the foundation.

Far too often, it feels like whenever we detect yet another thing wrong with our healthcare system, we get a lot of people together, different stakeholders, administrators, people who are directly and peripherally involved with whatever part of the system that went wrong, and try to get to the heart of the matter. But more often than not, we are unable to truly bring about the change we need to make sure that everything goes right for every patient every time they interact with our healthcare system — often, we just end up making things more complicated.

Look at what happened with our attempts to help better manage pain in our patients. Many years ago, in what ultimately led in part to the opioid crisis that has been so damaging to so many of our communities, large bureaucratic institutions demanded that we make pain one of the vital signs at each office visit, and refused to let us see any patient without a full pain assessment and a plan to make it go away. The problem was, we really didn’t have the right tools to adequately address their pain. All we could really do to drive patients’ pain scores down to zero — as these groups demanded — was hit them with opiates.

We’ve all seen how well that worked.

More recently, in response to the mental health crisis coursing through our nation, the powers-that-be have insisted that everybody be screened for depression in every primary care setting, whether that’s what they’re there for or not. So once again, we are left with a score that we need to do something about, most often without the right tools.

We lack access to mental health teams in the numbers the problem demands — be they social workers, therapists, or psychiatrists, either within our institution or out in the community — to adequately address the true level of mental health needs that we know our patients have. So instead of insisting that we ask everybody, wouldn’t it be better to start at the beginning, to build a system in which we can provide the services our patients need in an effective and efficient way?

Instead of being a reactive system, we need to take a good hard look at everything that we do in our healthcare system today, and break it down and ensure that we are doing every part of healthcare the right way. We have recognized massive inequities and injustice in healthcare, providing separate levels of care for different communities based on their insurance and other implicit biases on our part. To come at this from the other side, instead of reflexively reacting to every problem by trying to layer on a short-term fix, we need to get to the root of each and every problem.

When a result is missed or a delay in care occurs, we need to ask why — and then provide the resources to make sure this never happens again. When a patient’s insurance company denies care we believe they need, we need to shout until no patient is ever denied care again. When some cannot get access to telehealth due to uneven access to technology and other resources, we have to say how unacceptable this is and demand justice.

Yes, we need better data to study what we’re doing wrong. We need to be able to know the demographics of our patients, and to study where and why we’re not providing everybody what they need. But instead of looking at things after the fact, perhaps we can focus on looking long and hard at the root of the problem and going all the way back, to say that everybody who comes to us for help must get the care they need no matter what. I yearn for the day when nobody calling up seeking healthcare gets asked what kind of insurance they have, and that we no longer use this as any sort of filter for who they see and what care they receive.

Many years ago, in the name of social justice, I remember my college moved towards aid-blind admission, making sure that a wider diversity of students were able to get into the places that had previously been barred to them. We need to make our healthcare system the same, make sure that we open the doors and welcome everybody, and once we’ve ensured universal access — then and only then — can we continue to break down the things that are leading to inequitable care, inequitable access or uneven access, medical errors, poor outcomes for patients, and provider burnout.

Instead of reacting, putting a Band-Aid over a festering wound, we should strive to rebuild our healthcare system to be the kind of place for caring and healing that we would all want to be taken care of in. Reacting seems to only make things more complicated, more prone to complications, confusion, and errors. Becoming a proactive healthcare system built on a solid foundation of equity and social justice must be the only way forward.

Forward, ever forward.

Articles You May Like

Clinicians Need More Training in Nutrition Education and Spotting Hunger, Biden Says
Why Monkeypox Spreading In Wild Animals Could Spell More Trouble For Humans
5 Diabetes-Friendly Pumpkin Spice Products to Try This Fall
Dogs can detect changes in breath and sweat produced in response to stress
Financial wellbeing: The crucial link with mental health and the role of employers in tackling the cost of living crisis

Leave a Reply

Your email address will not be published.