OUR HEALTH CARE system is in critical condition. Only bold, systemic intervention will ensure its long-term well-being.
The indicators are everywhere: On the West Coast, over 24,000 nurses and other health care staff at Kaiser Permanente have authorized a strike largely over working conditions. Closer to home, a nursing strike at Saint Vincent Hospital in Worcester has entered its eighth month. Nationwide, health care workers are burnt out, worn down, and, despite the heartwarming scenes of hero’s welcomes at the shift change in the early months of the COVID-19 pandemic, they are increasingly being assaulted on the job.
Many physicians, nurses, pharmacists, technicians, and other health care workers have clearly internalized that they can shift to a profession that doesn’t put themselves and their families at risk, that doesn’t require the enormous commitment of time and compassion, and where hard work and good outcomes will be valued and recognized.
This is why health care workers are retiring and leaving the profession in record numbers. They see an easier life and an opportunity to pursue other passions.
While the pandemic has done damage to our health care system, it is not the sole cause of the current crisis. Rather, it further exposed the vast inequities in our system. The disparities in care and outcomes based on where you live and the color of your skin are stark. Maternal mortality rates, hypertension, and diabetes are just three examples. COVID-19 infection and mortality rates based on location put a finer point on a problem as old as the system itself.
While consumers once simply selected a physician they wanted, they now must make labyrinthine decisions based upon their employer’s negotiated relationships with health systems and accountable care organizations. There is nothing user-friendly about the process of finding a provider.
The health care system is an increasingly competitive business landscape where some organizations thrive while others hobble along. The lack of a level playing field leaves some institutions – like those in some of our poorer cities – perpetually disadvantaged.
We once had a more robust health planning process in place in Massachusetts designed to coordinate service delivery, align resources, and control costs. Additionally, a rate setting commission established rates of payment for health care providers.
We need to re-engineer our current system to ensure a more equitable distribution of health care resources and here is what needs to be done:
Culture: We must create the type of culture to which employees are eager to return; not one where skilled health care professionals feel the need to change careers and pursue other opportunities because of the unbearable burden of staying safe, the inability to provide care in the way they would like, and rapidly evolving technology that adds to the strain. Any redesign of the culture must include a recognition of the inequities and disparities that exist and an explicit commitment to address them.
Control: Boards of trustees ultimately provide the control for a health care organization. This governance must be pure, transparent, and free from financial conflict.
Collaboration: We must foster collaboration among the major players rather than divisive competition. This may mean that leaders of these systems have to invest in their strengths and phase out what is duplicative and oversaturates the market. We should have centers of excellence, not centers of everything.
Contribution: We have to acknowledge the valued contribution that all health care employees make in keeping patients well. If the best surgeon in the world must operate in an environment that is not sterile, then the result could be disastrous, and thus the custodial staff is as vital as other members of the care team.
This notion was advanced decades ago by the late Dr. Michael DeBakey, the famous heart surgeon, who would regularly take time out to speak with support staff, and the gap that he was addressing still persists today. Valuing people means compensating them fairly but also making them feel respected in their daily work so that they want to stay in their jobs.
The leaders of our health care institutions are all driven by a shared mission to provide the highest quality care, which has been the Commonwealth’s trademark. It is time to build on that commonality and create a healthy, equitable, and sustainable business model so that all patients can be served well.
Ellen Lutch Bender is president and CEO of Bender Strategies, a health care strategy firm.