Brick and mortar will not heal all that’s wrong with healthcare

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Originally published by FierceHealthcare


In the movie 300 a messenger asks King Leonidas for “a simple offering of earth and water.”

300 Earth 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 each represent power, conquest, legacy, achievement and yet are not always in line with what is best for the populace, for all those we should be honored to care for and care about.

Much time, energy, capital and human resource have been invested in brick and mortar in the healthcare system with much pomp and circumstance and celebration of same.

But does a new building represent a true achievement when those within the building, i.e., doctors, nurses, staff, patients, families, are being harmed? Are we truly focusing on the right priorities?

Should we be reprioritizing (which requires we each check our own ego) and focusing on improving the healing model itself prior to brick and mortar (and only progressing toward building when that path truly serves our mission to help others)?

In the article I wrote some years ago for WPA Hospital News, Where are the adaptive leaders in healthcare? I provided an account of a leader at a local community hospital who shared a “success” story about emergency room access.

The challenge at hand included a dramatic increase in emergency room (ER) visits, the lack of efficient access to the floors (patient flow), and high numbers of patients waiting too long for care (access).

The technical solution was a significant capital investment and building an expanded emergency department at this hospital — using brick and mortar (or earth and water) to solve the problem.

Now at the end of the day, the expanded emergency department might have been the best solution, (might have aligned with the best path that truly serves the mission to help others). 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. No one spoke to the doctors and nurses and staff on the frontlines. No one spoke to the patients and families. And no one listened to any of the above.

In the end, no one worked with these individuals (this community) to decrease the reliance on the ER.

The emergency department was expanded, it was deemed a success, the achievement was celebrated. Yet the reliance on the ER has not decreased, and in fact with the expanded ER the hospital now has a perverse financial incentive to continue to increase the reliance on the ER rather than work toward healthcare improvement and decreased ER visits (ensuring patients are seen in the right location, at the right time, for the right reason, for the right service).

Now also consider the Institute of Medicine’s declaration that half of all medicine (healthcare) lacks scientific validity and Dr. John Ioannidisfindings that much of clinical research is misleading, exaggerated, flat-out wrong AND harmful. (NOTE: And yet is considered evidence-based medicine).

Does “brick and mortar” address the lack of reliable, trusted and understood, clinical research and the lack of truly appropriate evidence-based treatment protocols that lead to harm or is it simply gild?

Does “brick and mortar” address the perverse financial incentives in the system or, on the contrary, does it contribute greatly to the perversity?

What are our priorities? What should they be?

Absolutely, new medical office buildings can be impressive works of architecture and construction that are sometimes necessary and can have a positive impact.

But is the system (are we healthcare leaders) just as willing to invest in truly fixing the broken model itself? To ensure high reliability and optimal outcomes aligned with our understanding and the needs of all those we lead and serve and care for and about?

Instead of an offering of earth and water how about an offering of a healing model built on a foundation of engaging and caring for doctors and nurses and all staff, on engaging and caring for patients and families and communities, on listening to each and focusing on truly understanding and a true north of service to others. One where care protocols are based on reliable clinical research where optimal safety and quality is the only goal, not the numbers of papers written nor the funding each generates (unreliable research) nor the number of beds filled, increase in ER volumes or patient visits (perverse care model).

Let’s lose the ego and stop building monuments and legacies of brick and mortar at the expense of the health of individuals and communities.

Let’s reprioritize and focus our resource on truly fixing the healing model itself and then …

Let’s have a real celebration.



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