A theme last week across the internet was patient-centered care.

Paul Levy started with this post. (BTW - If you happen to be a health care amateur, you should be reading Mr. Levy’s blog. He is the CEO of Beth Israel Deaconess Medical Center and one of only two CEOs that I know of who blogs, and writes on topics that most hospital CEOs wouldn’t.)

Nick Jacobs posted this (he is the other CEO that blogs, he works at Windber Medical Center, a Planetree hospital that seems to have actually made the patient its “first” priority). Mr. Jacobs’ post is in response to CNN news personality Glenn Beck’s personal encounter with the health care industry. The Health Care Blog also picked-up Mr. Beck’s patient-care problem.

As it happens, Mr. Jacobs happens to be at Hospital Impact discussing a recent article in the New York Times that discusses recent research suggesting poor physician/patient communication (really? but, it is a two-way street). Advanced cancer patients don’t seem to be displaying much emotion in the presence of physicians.

Quite a few instances of empathic issues in a relatively short period of time. People often have a strong distaste for hospitals based mostly upon how they are feeling physically when they arrive at the door. We can’t change that. We must recognize that we have an opportunity to change perceptions when a patient seeks care (and if you explore any of the blogs I have linked to in this post you will find multiple examples of providers who deliver exceptional care). What we can change is this: how each and every one of us relates empathetically to patients (including administrators, direct patient care personnel, housekeeping, etc…).

In his book A Whole New Mind, Daniel Pink tells us that the Information Age is over and in its stead is the Conceptual Age (I am a futurist so I really enjoyed the book, but no matter your thoughts on change, read his book, I promise you will enjoy it). Short (doesn’t really do it justice) summary: Traditional left-brain thinking (Pink calls it L-Directed) will give way to right-brain thinking (R-Directed) for several reasons. To deal with this transition we must develop six senses. One of the senses is empathy: “Empathy is the ability to imagine yourself in someone else’s position and to intuit what that person is feeling.” And lovely for us, Pink talks about how empathy directly impacts health care: physicians need to empathize with patients to provide the proper level of care to today’s patients. Medical schools are building communication and empathy skills into their curricula.

This is just a start. As a system we must not depend on our employees entering our facilities with the necessary level of empathic education, we must develop programs to build and foster empathy in every employee that works for us.

And even if empathy doesn’t improve patient care directly (I for one feel that it will, and Pink gives a poignant example in his book), it is the right thing to do as humans.

Principle #1: every employee in our own system works to serve patients. Patient care will be the reason for every decision we make.

UPDATE! Some more on Mr. Beck.

It has been about a month since Dr. Atul Gawande’s article “The Checklist” appeared in the New Yorker (if you go there to read the article, be prepared…it’s lengthy, but worth the time). If you don’t have the time check out Maggie Mahar’s slightly shorter summary here at Health Beat Blog.

The basic point of the story is this: Dr. Peter Pronovost instituted checklists while working at Johns Hopkins Hospital in critical care. And guess what happened? Dramatically improved care. AND it even saved money.

Dr. Pronovost proceeded to export his checklists throughout the state of Michigan and again a substantial number of patient lives were saved to go along with significant cost savings.

These great results were published in the New England Journal of Medicine and then checklists were rolled out across the country, right? You would think so. But it didn’t happen. In fact, as Ms. Mahar puts it: “In December of 2006, the results were published in The New England Journal of Medicine. How many U.S. hospitals have adopted checklists since? None.”

Why? Well it seems the answer is written here in an op-ed by Dr. Gawande in the New York Times. Ms. Mahar provides her always insightful analysis here and here. The federal agency Office for Human Research Protections is preventing the use of checklists.

That’s a tough pill to swallow. Here we have a health care innovation that saves lives and delivers significant cost savings but is unable to cut through government bureaucracy.

And then after all of that, in a slightly different vein, Reuters has a story from Hong Kong on the use of checklists.

UPDATE: Some more and more on checklists.

“The significant problems we have cannot be solved at the same level of thinking with which we created them.”

- Albert Einstein (attributed)

On an eve, not so very long ago, a couple of health care amateurs set out to change the world…

…and then we realized that we didn’t know anything.

And rather succinctly I’ve arrived at my point: one must be smarter than Einstein to really change our system and bring about an era of sustainable health care.

So we’ve returned to school for more education (obviously we have taken getting rich off of our lives’ to-do lists, we acknowledge intrinsic motivation for setting our sails toward this career path) and quickly realized that the classroom is a great place to understand concepts (and we appreciate the tutelage we have received thus far–for it would be much more difficult without our professors’ great insight) but time constraints placed a limit on our discussions. And for those of you who have studied health care know how impossibly difficult it can be to understand that many people consider health care a real business (they do what!?) (hold on, hold on, hold on, hospitals get paid how!?) (so you’re telling me that doctors don’t work for health systems? well, right, most of the time. what!?) (it is…a business I mean, one that seems to operate very differently at almost every turn). And this can all become very frustrating, so we started spending our free time (”you have to be nuts”) talking about health care. Questions (tons of them) were raised while answers (probably even more) were tougher to come by based upon our limited experience.

Solution? Solution: our own system.

What better way to fix the health care system in this country by just starting over and starting anew (Second Life is for real). OK, not exactly plausible in a service industry that provides tangible care (you never know!). But we can talk (write!) about a virtual system. So we started a blog to serve as the internet home of our community. We’d be happy if our writing just improves our understanding of what actually goes on. But I envision much more (patience is a virtue). And we’d be happy to entertain (in fact, we encourage) the thought of other health care amateurs joining us here and providing valuable thought diversity and insight.

OK, so what is sustainable health care? I don’t have a clue (finding that answer is the mission of this here blog). Through community exploration and interaction we will:

- question the way things are in this system (seriously, because we don’t know)

- wonder (write, is probably more truthful) aloud the reasoning behind all we do

- and hopefully, along the way, by just conversing about the many conversational points there are sure to be, propose audacious (deep breath), bodacious (oh my!), and practical/useful/implementable changes

We’re not naive enough to think we have the ability to solve the (kajillion) problems in health care (yet!) but we are smart enough to realize that sometimes fresh perspectives are (pardon this awful expression) exactly what the doctor ordered. We haven’t been around long enough for the system to eat up our appetite for changing the world or diffuse our excitement for doing good. It has not consumed us yet (and I pray everyday that it will not).

This is at its very core a learning exercise aimed at making us all more knowledgeable.

So with that, we break the customary bottle of champagne over the bow of our own system, welcome.