There was a doctor. The doctor had an office. In the office, he had a practice. The doctor worked hard, was honest, smart and compassionate. He took care of many patients, everyday, and helped many people. The people paid with cents, checks, and chickens. He was solo, alone, by himself. It was good.
There was a hospital, near the doctor. It was an important hospital. It took care of many patients, everyday, and helped many people. The hospital was alone, by itself. It was good.
And, there was a nursing home.
And, there was a pharmacy.
And, there was an insurance company.
And, there was big pharma.
And, there was a medical school.
There were nurses, health planners, administrators, architects, system analysts and many other smart, compassionate, hardworking people. They all took care of patients, everyday, and tried to help many people. They were each all alone. In boxes. In silos.
Nonetheless, even though they did their best, even though they deeply cared, despite all their very hard work, it came to be that the people realized it was not good.
There was waste, mistakes, and confusion. There was duplication, anger, and fear. There was pain, suffering, and death. Patients got sick and the harder all the people in all their silos tried, they made everyone sicker.
So, the people said, we have to get together. We have to talk. We have to think and plan.
It was a good idea. A bright light. However, there was a terrible problem.
The people did not trust each other. The doctors thought everyone was out to get them. The nurses got no respect. The administrators could not get anyone to listen. The nursing facilities were an afterthought. The drug industry was about profit. The medical schools were not sure what to teach and could not get any patients for research. Financiers and industrialists believed the whole thing was expensive dysfunctional chaos. Politicians were a punch line. No matter what good works the insurance companies did, the people hated them more. Everyone was frightened of the lawyers, who though they tried very hard to connect, created obstructive bureaucracy.
Nevertheless, this was a crisis: Something had to change. Therefore, the people sat down at a big table. It was a very big table. It was so big that the people at the each end of the table had their feet in the water of different oceans. The people started to talk.
They did not talk, at first, about sick patients, cost centers, information systems, certificates of need, personalized medicine, blueprints, bond ratings, staff ratios, Obamacare (oh, maybe a little) or critical research. They did not start to rebuild.
They talked about language. They talked about priorities. They shared their dreams. They learned about each other, and what each silo, each box, was trying to do.
Why did the lawyers love contracts? Why did the planners need metrics? How do computer designers write? Why does the CFO love EBITDA? What in the world is translational medicine? How do insurance companies work and what do, they really want? How does government and health policy happen? What does a doctor feel when it is 6:45 p.m. and they are 90 minutes behind, and they haven’t seen their family in a week and the patient in front of them takes out a long list and there is a scream in their waiting room and the EMR crashes?
A marvelous thing happened. As all the people in all their loneliness learned about each other and what each was trying to do for patients and the communities they loved, they learned that they had much in common. They could help each other. Team meant something broader, more universal and powerful, than just the one person in the next room. Together they had an incredible opportunity to take all the great things they had built alone and, as one, change the future.
Then, there were no more boxes. Everyone left their safe isolating destructive silos. They became one immense, powerful caregiver with capacities, and energies never before dreamed. Colleagues, collaborators, and compatriots. They spoke one language; the language of healing, and health. The language of balance, efficiency, and empowerment. The language of exploration, research, and innovation. The language of hope.
And the walls came tumbling down.
James C. Salwitz is an oncologist who blogs at Sunrise Rounds.
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