18
May
2007
One of the things I love about healthcare is that communities of patients and caregivers come together to do more than treat conditions. They create support groups, they advocate for research dollars, and they spread the word about the medical conditions that bring them together. For the patients and their families, the medical condition, be it cancer or MS or Down Syndrome, defines their lives. It becomes a part of who they are. For the caregivers, it is the passion to care and cure that drives them.
They become experts and advocates.
But what happens when the “fight for the cure” has unintentional side effects? What happens when there are fewer and fewer people with the condition? What happens to the community then?
Such is the problem for patients and families with Down Syndrome. In a wonderful video on the New York Times website, journalists Amy Harmon and Kassie Braken explore the shrinking world of children with Down Syndrome. With the early detection of down syndrome in fetuses and the extremely high termination rate of those pregnancies, the prevalence of children with the condition is sharply declining. And with that decline comes a loss of shared experience and knowledge about raising children with Down Syndrome, about their life expectancy, and about who they are as individuals. In the case of Down Syndrome, “finding the cure” (indeed termination is in no way a cure) comes at the diminishment of the community.
Healthcare is full communities that are fighting for cures. The fight for the cure gives purpose, and sometimes meaning, to people that are struck, at random it often seems, with disease. About once a generation we are able to cure a disease and with billions of dollars spent on medical research each year that rate is bound to increase. As we celebrate the victory of our medical discoveries we need to remember to care for those that weren’t lucky enough to come after the cure, those for whom the cure is bittersweet.
Andrew 
Doing Right 
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13
March
2007
It is a story that the papers run year after year. A working mother has her medical bills laid out on the table. They are overwhelming. She just doesn’t know what to do. She has to put food on the table, but the creditors are calling. Her only goal was to raise her two boys well and then she got diagnosed with cancer.
It is a compelling story and according various stats it is not uncommon. It is the plight of the under and uninsured. If you aren’t lucky enough to have healthcare coverage through your employer, then one major medical crisis and it could happen to you. You could be a great person, contributing to society, but at the moment you are between coverage and then bam, it hits you – a heart attack, a car accident, a weird disease that you have never heard of that puts you in the hospital for a week.
What do you do then? What should society do? If I have taken a position on anything in the “fixing healthcare” debate it is that we have to give the purchasing decisions and hence the responsibility for payment to the person that has the most interest in the outcome: the patient. Now that is not synonymous with “every man for himself” – if you get cancer then you have got to pay for your cancer. But (and here is the but…) if we as a society are going to decide to pay each others medical bills (or share each other’s risk), then we have to make a conscious decision to do so as a nation. We can’t just say “let’s fix the system” or “let’s make health insurance available to every American”. I honestly believe that won’t work.
The conversation needs to be about the common good or the benefit we all share from knowing it won’t be me that gets financially wiped out when misfortune strikes. In Catholic healthcare there is the concept of social justice, of the equitable distribution of medical resources, of providing for the most vulnerable in society. I think these are the concepts that should be at the forefront of our national discussion. I am not even proposing this because I am huge social justice advocate, I am proposing these topics, because these are the real decision we have to make about how we are going distribute our medical resources. With consensus around these issues, the money part of the conversation will work itself out.
Andrew Fixing Healthcare 4 Comments »
28
February
2007
So I am in HR now and it is actually pretty interesting. I feel like I am in a foreign country and am learning their language and culture. Their focus is very different than the focus of hospital operations. HR folks have particular expertise - labor law, recruitment strategy, benefit administration- and that is their world. They apply their knowledge in support of the hospital, but they are at least one level removed from what is going on in the hospital. Instead of the daily census, patient records, and practice guidelines, HR folks focus on requisitions, employee files, and compensation programs. I am not knocking HR. What they do is really important for the hospital, but I am seeing that this disconnection between HR and hospital operations really limits HR’s impact on the later.
I think it is no secret that HR has not typically been seen as a strategic partner in the past. Many HR departments focus on the transactional work of moving paper around. This, of course, is a great service to the hospital, as much of the paperwork is required for legal compliance. HR also deals with those technical, but important hiring/firing/benefits/compensation issues, so that operational managers don’t have to, but, honestly, these are not seen as high value activities. Oh, and HR folks are also good for dealing with unions.
The good news is that HR can play an incredibly strategic role within the hospital. It just takes a little change of perspective. What is the biggest category of cost for every hospital in America? That’s right, labor. So who owns “labor”? The manager. Yes, but also HR. HR recruits for vacant positions, so that nursing doesn’t have to call upon agency nurses. Got employees with strained backs from lifting patients all day? Go see your friendly employee health nurse (often associated with the HR function). Got employee morale problems. Let an HR organizational development specialist facilitate a teambuilding, offsite activity. Are you a bad manager? We’ve got training courses for that too.
Of course, many HR departments do these things already. But filling job requisitions and providing training courses is not the ultimate measure of success for HR. The secret is leveraging these skills to achieve hospital strategic, financial, and operational goals. If you can focus your HR folks on these things, then HR can truly be a strategic partner.
Andrew Leading Healthcare No Comments »
