Tuesday, May 24, 2011

Being a Change Agent - the Critical Competency

There is hardly a day that goes by when the newspapers and TV news broadcasts are not sharing an important set of new inofrmation concerning the healthcare delivery process in the US. Just last week, two important articles were headlined......
         "Study: ERs shrink as demand rises"
         "New Nerve Stinulation Technological Makes a Paraplegic Walk"
Both of these articles reinforce my belief that the hospital of the future will look very different than that of the past and two major drivers of healthcare will continue to be the access point for the patients to recieve their initial care, and the technology that will be available to diagnosis and treat them.
Inorder to be successful in the future, I have been stating that healthcare systems will need to be capabale of providing  high quality, low cost products and services. The ability to achieve these goals is to assure that the patient receives their primary evaluation as quickly as possible, and that the addition diagnosis and treatment plans required are well coordinated. Certianly the trauma side of our Emergency Departments are not the place for the average non-acute patient to be seen. However, because of the lack of primary care entry points in the US due to the paucity of primary care physicians, and the reluctance of many physicians to embrace physisican extenders, most Emergency Departments have created non-acute tracks that function much like a primary care doctor's office, and make them available often 24 hours a day, but if not, at least 10am to 10pm. Recognizing that these non-urgent care tracks provide a stop-gap measure for many patients until we solve the primary care capacity issue, what will be the change needed to address the fact that the first article indicated that 1 in 3 ERs have closed over the last two decades. And even more serious consequences come from the reasons for the closures........
       >Have low profit margins
       >Serve patients below the proverty level
       >Serve those with lower forms of insurance, including Medicaid
       >Those in for-profit hospitals
       >The ones located in more competitive markets
All of these reasons cause problems for a large number of patients in the US who have, at this time, no other access point.
With regard to the new nerve stimulation technology story, this is supporting our prediction that neurosurgey will be a growing and changing service line which will provide more and new tretaments in both the inpatient and outpatients settings. These treatment plans will require much more space for intense reabilitation which, in the past, has not alwyas been profitable and therefore have not been incorparated into the offerings of many local and regional medical centers. And long reabilitations times for any patient are not best delivered miles from where the patient's family and support persons live on a daily basis. And if this technology can be made afforable and expandable to many other quads and paraplegics, present technolgies such as rotating beds, electrtic wheel chairs, and services such as "help dogs" and visitng home nurses may have to change what they are doing to serve the patients of the future, not the past!
What does all this mean for people working directly or indirectly, in tthe healthcare industry. Change will continue to occur at a rapid pace, and those that can embrace these changes with enthusiam and with passion will be both the formal and informal leaders of the future. Yes, being a change agent may be the most critical competency for healthcare providers as the future unfolds! these are interesting times, worth watching closely.

Wednesday, May 11, 2011

Understanding the Brain as Well as the Heart!

As we envision the hospital of the future and the service lines that will be offered in the acute setting, it is important to recall a prediction in a prior blog that "in five to eight years we will know as much about the brain as we know today about the heart". The outstanding preventive care, as well as, treatment plans that we can now offer cardiac patients is astounding and, as a result, cardic disease will soon fall behind cancer as the number one killer in the US, quickly followed by trauma., which is catching up fast (see prior blogs on this topic). It is important to note that all this advanced care for the heart, including the training of paramedics, the development of mobile ICU's , the staffing of cardiac care units, and the development of coronary artery stents occurred in the last 25 to 30 years. And now heart bumps to supplement failing heart muscle are becoming common place. All of this proves, that with focus, much progress can be made in a relatively short period of time.
Using that as a predictor of the future, I am comfortable that we are making rapid discoveries surrounding brain diseases and therefore, we are approaching the time we will know how to treat and even prevent significant brain abnormalities such as alzheimer's,  parkinson's, and other chronic dementia abnormalities. We have all ready seen significant advances in stroke prevention, as well as stroke reabilitation. The preventive measures are now being spread to small community hospitals through neurological telemedicine programs, where neuro specialists, both doctors and nurses, are available 24 hours a day to observe patients in any Emergency Department with the video equipment, guiding the local staff through the appropriate treatment plans. Numerous bairn tumors, including metastatic ones, are sucessfully remorved with stereotactic and cyber-knife techniques.
In addition to all of this great progress, we are now reading about potential treatments for parkinson disease patients using techniques to deliever drugs directly to the brain, which has been difficult in the past due to the
blood-brain barrier which inhibits normal drugs from developing high concentrations in the fluid surrounding the brain and the spinal cord. These treatments will use drug  pumps and catherters, which will require insertion in ambulatory surgery centers or in the inpatient setting for a 1 or 2 day stay. We all ready have successful treatments for some parkinson patients who have benefited from implanted electrodes that provides electric stimulations to parts of the brain that control the disease process.
How will all of this effect the healthcare industry? Some of the beds now empty in the inpatient settings because of ability to care for many patients totally in the outpatient setting will start to be filled with patients getting new therapies for brain disorders. "Brain Centers", encompassing a wide variety of treatments, some curative,  for a large number of now untreatable brain abnormalities will spring up across the country, much like the national cancer center movement we are now seeing. Locked units for dimential patients will have to change and perhaps will no longer be needed. Wouldn't that be wonderful.
We learned alot about the heart in a short period of time. We had to because of the number of people who were affected by cardiac disease. As we are successfully treating many heart patients helping them to leave more healthy lives and as the population continues to age, abnormalities of the brain are moving to the forefront. As it was the "heart's time" 25 years ago, it is now the "brain's time". Sit back and watch as we learn as much about the brain as we know about the heart!