Saving lives, lowering costs and improving access the old-fashioned way (revisited)

This week Scott Kashman, Chief Administrative Officer, Lee Memorial Health System, wrote a great post for Hospital Impact: It takes a village to tackle hospital ER overcrowding (a great read, very informative and includes a call to share and learn with one another).

Reading Scott’s thought provoking post reminded me of a wonderful learning experience I had thanks to a courageous Physician Assistant from Northern Maine and in which I wrote about back in March of 2011 (also for Hospital Impact).

So with the prompting from reading Scott’s post today I am reposting that story below. And again, please take a moment to read Scott’s. It is well worth your time.

Thank you.

Saving lives, lowering costs and improving access the old-fashioned way

Earlier this month [March 2011] Bonnie Smith, RN, Gov. LePage’s Deputy Commissioner of the Department of Health & Human Services, shared the administration’s perspective on health policy in the state of Maine. Smith shared the goals of improving access, ensuring accountability, reducing costs and improving the health status of individuals and communities. Wonderful aspirations and clearly hard to argue against.

A question and answer session soon followed, along with a discussion concerning the challenges of emergency room overutilization. A number of individuals stood up to impart how they are addressing the issue.

Some solution plans included building hospital-owned urgent care centers closer to where those who are using the emergency room the most live and building primary-care practices inside the ER. Both would perhaps be effective and definitely costly.

While this discussion is taking place, I am furiously putting notes to paper so that when it is my turn to respond I am well-prepared. I make note of Dr. John Ioannidis’ findings that 80 percent of non-randomized studies turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials, and yet they are still the standard of care in many cases. I jot down that the Institute of Medicine has declared that half of all medicine lacks scientific validity. I reference the most recent study out of Thomas Jefferson University Hospital in Philadelphia, which showed diabetic patients have better outcomes with empathetic doctors, along with Dr. Helen Reiss’ findings regarding the impact of empathy in the healing process.

So, yes I believed I was quite prepared to articulate the need to truly adapt and change the healing model and thus reduce ER utilization and address those key items laid out by the Deputy Commissioner.

And then it happened … Before I could look up and raise my hand, a physician assistant (PA) from Northern Maine had been selected to speak and shared the following [paraphrased]:

I know how to address the issue of overutilization of emergency rooms. I do it every day. I know the people who would utilize the ER. I talk to these people and I listen to these people. I have developed relationships with these people. They know me and I know them. We trust one another. When they have a concern they call me and we talk. And when they should come to the ER they do. And when there are better options I help them to understand those options. It is all about relationship and trust.

My gosh, this PA said in a few sentences what would have taken me much longer to say. This PA on a daily basis lives what theorists, administrators, politicians, “experts” and others can only surmise. This amazing individual is in a system where she can positively impact the lives of patients, save the system money, and is doing so by leveraging relationship. Relationship. Empathy. Trust. And the ability to truly listen.

How amazing and wonderful and inexpensive and effective and a “no brainer.” Right? Perhaps not…

I went up to this PA (who I had met a few months prior) and hugged her and said how much I appreciated what she said. She told me that she did not think they would pick her to speak as she is considered a troublemaker.

A troublemaker?

Well … “Here’s to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square hole. The ones who see things differently. They’re not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can’t do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.” – Apple Computer, Inc.

I left that Q&A session having been reminded of two important lessons. First, listen and heed the input from the so-called “troublemakers” (who in many cases are people on the front lines of healthcare). They are the ones in the know. And as Apple knows, “They will push us all forward. They will change the world.”

Second, ensure that relationship, empathy, trust and the ability to truly listen become as important to any new healthcare model, as to any new revenue generation strategy, any new alternative payment model, any new technological advancement, or any other “innovation” reliant on the broken parts of the existing system.

Thank you, my Physician Assistant friend, for saying so succinctly what we all needed to hear.



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