An essay posted by Fareeha Kahn, MD (“A hospitalist’s struggle to find teamwork in academic medicine“), raises an important issue. The problem of lack of collaboration is not unique to academic medicine. The problem is the result of misaligned incentives.
Having read the work of Harvard Business School professor Michael E. Porter, I better understand the goals and challenges of value-based care. If we look at the premise of Dr. Kahn, the hospitalist complains about the lack of effective hand-off, and the abandonment of the patient to the outpatient “ether.” Dr. Kahn is scrambling when attempting to schedule an outpatient visit for a soon-to-be discharged hospital patient. There is fewer staff handling more patients in doctors’ offices. That includes the job of scheduling appointments. One essay from my upcoming book refers to the chaos in the emergency room, particularly when an ER physician attempts to transfer a patient to a tertiary hospital for an invasive procedure unavailable in his community hospital. When push comes to shove, success on the 23rd phone call by the ER physician is not a success but rather a sign of the lack of a sense of responsibility for the patient.
Dr. Kahn talks about bolstering her consult by justifying “metrics” that impact the hospital’s revenue, including the readmission rate after 30 days. If the patient continues to deteriorate outside the hospital because no one has been responsible for that patient’s care as an outpatient, then the likelihood of readmission increases for similar or related health problems.
“What is best for this patient?”
That is the question that every care team member must address, each in his or her own context of expertise. But for a team to have good chemistry and an attitude toward execution, individuals must defer self-interest. When every care team member has skin in the game (compensation based on best medical practices with an eye to reducing cost), the goals for the patient and the team’s goals align. Dr. Kahn regrets the lack of compassion shown by health care workers who have been stressed to the point of burnout. That is not unique to academic medicine, to be sure. When health care professionals collaborate effectively, everyone gains.
As models for value-based care mature, in which goals and methods work to bring greater value to what is being spent on a patient’s care, we may begin to see what real patient-centric care looks like. Collaboration by health care professionals is an essential element.
Paul Pender is an ophthalmologist and can be reached at his self-titled site, Dr. Paul Pender. He is the author of Rebuilding Trust in Healthcare: A Doctor’s Prescription for a Post-Pandemic America.
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