Into the deep waters of health care

immersion
[ĭ-mer´zhun]

  1. the plunging of a body into a liquid.
  2. the use of the microscope with the object and object glass both covered with a liquid.
  3. a state of being deeply involved in something.

HFH multidisciplinary team during rounds.

A popular approach to gaining exposure and understanding of health care is immersion. These experiences generally take an individual who has passing or limited direct health care knowledge and place them in situations or environments where they can get some understanding of this world. A world that those of us in the trenches live each day, but others find foreign. Foreign sights, sounds, smells, language and actions. A foreign business model, foreign processes. This is the tip of the spear of health care, and to understand health care one needs to have an unimpeded view of how care is delivered and the reality of modern health care.

When we immerse someone, we often take certain approaches. All of us do. We should call it, “shock and awe.” Start with “shock” and what better way to shock a lay person than a trip to the emergency department (ED), especially a busy urban Level I trauma center like Henry Ford Hospital. The hospital equivalent of orchestrated mayhem that generally scares people. An opportunity to show others why we are different and special, because we can tolerate the blood, the fluids, the chaos and the pathos. We have been through the gauntlet.

But wait, up to the hybrid room in cardiac cath or the robotic suite, we love to show the “good,” our achievements and our wins. How we have mastered technology. The hospital equivalent of show and tell. Look at what we can do.

I love both of these critical areas of the hospital and the people who work in them. But neither of these, despite spanning the ends of the spectrum of what we do, paint the common reality. They depict only what we want others to see, to understand, to praise, to influence.

These experiences do not create “a state of being deeply involved in something.” For those that we intend to have this deep involvement, individuals who will take their place in non-care delivery parts of a health care organization, like many in administration, or make decisions with management to better our organization, like new board of trustees members, we need immersions that paint a clearer picture of what health care is today, how it is practiced, and how we all will need to respond to create our most important product, health or a return to health.

So after our theater of “shock and awe,” I would provide a modest suggestion. I suggest that one of the best health care immersions is to attend progressive care rounds. These rounds, conducted on each non-ICU floor for an hour daily, are meetings of physicians (attendings and residents), nurses, care management professionals and pharmacists. The primary intent is to review the status of each patient and determine where they are in their hospital course, what needs to be done to get the patient better and prepare the patient for discharge.

Each time I attend these rounds I am struck by several observations. How remarkable our team members, mostly young professionals (All right, I know, who isn’t young in comparison to this retiring CEO?), most much younger than the patients, are in their knowledge, professionalism and concern. How molded by experience, by the realities that they deal with daily, the factors of human frailties, many times self-imposed, the emotional strings that are pulled, the often overwhelming demands placed on them by patients, families, and the system, and the impediments that our insurance industry often has placed on clinical care decisions.

The immersed will learn a bit more about how truly complex patients in modern hospitals are. And I do not mean the patients with high case mix index (CMI) or “tertiary quaternary” designation. The complexity of patients with common illnesses, often times multiple in number, and often at odds with one another. Complexity both in their medical and their socioeconomic conditions. Complexity that most of us cannot imagine in our daily lives.

The immersed will learn a lot more about factors that affect clinical and care decisions. These are factors that are as foreign to many as the complicated language we use in our profession. The immersed will learn that clinical and care management professionals deal with factors that are a maze to navigate.

The knowledge base required to simply get a patient out of hospital is far greater than anything that the immersed have encountered. Individual rules of insurance companies in themselves requires a supercomputer to understand and make decisions. They will learn that patient satisfaction metrics do not speak to the difficulties encountered in the distressed patients and families in our hospital. They will learn that this is not an assembly line or manufacturing model, not the airline industry, not simple solutions.

But the most that will be learned is a new found respect, perhaps even reverence, for the observed attendees, some of the best young people in the health care disciplines, and some of the savviest clinicians one can encounter.

This is what health care is today.

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