“Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the United States drove about 10 times as many vehicle miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you were 10 times more likely to live through each mile you drove than your father or grandfather was 60 years ago.
Why? Are we better drivers? Nah. Seatbelts, airbags, tougher DUI laws, breathalyzers, graduated licensing for teenagers, anti-lock braking systems, better highway designs, crash barriers, rumble strips, median barriers, steel-belted radial tires that don’t blow out, crumple zones, better bumpers…system tweaks that work, that make it 10 times as hard for even a terrible driver to kill himself or you.”
–Joe Flower, How to Blow the Big One: A Methodology
With his comments on the reasons behind the dramatic drop in highway deaths, Joe Flowers, a prominent health analyst, has given us a useful metaphor for health reform.
In many ways, health system reform is like accident reform. Both travel along the highway of life.
- Every citizen, from the young to the old, is involved in one way or another.
- Accidents are common and costly and mostly occur close home.
- Concrete highways and information highways link us all.
- Systems engineering of cars and hospitals can be made safer.
- Government can serve as catalyst , e.g, building and maintaining an interstate highway system or introducing health exchanges in states.
A myriad of little things introduced on a broad scale over time, engaging all of us, can and will make a big difference between disabilities and premature death and a productive full life.
A lot of these sometimes seemingly disconnected things are occurring right now. Some are apparent, others are not so obvious, but all are part of the big picture of a rolling national reform effort.
- Hospitals are introducing safety features – pre-surgical checklists, protocols for infection control, standards for ICUs, measures of comparative outcomes. And, just as importantly, they are decentralizing their operations with freestanding ERs and outrach clinics and surgical and diagnostic units. new roads geographically nearer to patients.
- Physicians are installing websites and otherwise computerizing to address payer and patient concerns. They are introducing technologies – portable ultrasounds, implanted monitoring devices, predictive cardiopulmonary equipment to spot chronic disease early. Meanwhile telemedicine and electronic communication, especially mobile hand held gadgets, are broadening and deepening and patient-doctor relationships. Information technologies are changing the fundamental nature, of office practices and their connections hospitals, and patients.
- Patient empowerment and engagement is flowering as 80% of patients have Internet access, either at their homes, at work , or in local libraries, and as 80% of citizens use the Internet to search for health information. In the process disease and health care is being demystified, but it is being distorted too by misinformation. Most patients still trust their doctor to separate the wheat from the chaff. Patients are making it clear they prefer decentralized, noninvasive care and self-care, particularly in their homes surrounded by loved ones and family.
- The world of technology and innovation is responding to the needs of reform in multiple ways – by developing mobile devices with multiple apps, and by using data analytics to focus on where the greatest needs are, what patients are generating the most costs, how online real time information can facilitate more efficient and effective care, how robotic surgical machines can supplement human surgical skills, and how the information highway can interconnect everybody across the health care landscape.
- The government, through health care legislation, is trying to serve as the mastermind, guide, and catalyst for reform efforts for the various sectors. But government dictation of care faces tricky tasks– how to standardize and connect care across a diverse landscape without overwhelming society with suffocating and counterproductive regulations without increasing costs. This is not easy in a society that increasingly distrusts government, particularly big government far removed from the local scene. As Joe Flower has observed: “Reform is not the change. The federal health care reform law is a catalyst, and enabler, and an accelerator of the change we are going through. It is not the change itself, and is not even the cause of it, because the change is driven by much larger economic and demographic factors, especially by the crushing cost of health care. If the reform law were to go away, the change would not go away.”
The highway to health reform is paved with good intentions but it has many byways and roadblocks. Thanks to the commitment and engagement of multiple sectors of American society, it is headed in the right direction. As a result of health care reform, consumers, doctors, nurses, hospitals and decentralized health facilities across the country are innovating to reduce costs and errors, end duplication and waste, deploying technology to safely share information, and coordinate care between practitioners and settings.
Health reform is on a roll on multiple fronts. Patient crashes are going down. Don’t let the road noise bother you.
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