Healing of health care USA: Where are our priorities?

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An OpEd by Meg Helgert, FNP

This seems a bit of an oxymoron right? Healing of Health Care. Yet this entire system has Untitled design (2)changed in the 40 years I’ve been involved within its borders. I must say the EMS system has improved as people involved in automobile accidents now have a fighting chance because of the care they receive immediately at the scene. Technology has improved by leaps and bounds in preventing illness and repairing injuries. Medication are targeting health problems that have improved health since penicillin gained recognition in 1928. We have regulatory boards monitoring professional. We have hospitals with the latest in technology and state of the art in intensive care and neonatal intensive care.

So having mentioned all these positive aspects involved in 21st century health care what is the problem?

There is another layer that has developed right along with all the health care innovations and this is the administrative layer and insurance layer. This layer of combined elements is responsible for many of the great strides in building and developing facilities across the country; brick and mortar and the theme of care along with the luxury and perks seen in many hospital lobbies. Music playing in the elevators and classic lighting in the hallways.  Think about it.  The decision-making and priority-setting that comes from this layer is not based on clinical expertise.

money graphThis is what is so disturbing about the great lengths this layer will go to increase patients using their facility. It’s a brand, name recognition. This all comes at a price which is embedded in health care premiums. This group alone has brought health care into the 21st century in terms of the iconic approach it uses to lure famous physicians to use their facilities; highlighting the latest technology and state of the art facilities.

The price paid for this along the way is that the true meaning of care has been lost in the glare of the bright lights and stardom and fanfare.

Health care is not glamorous by any stretch of the imagination. It can have awful outcomes; gut wrenching consequences and unhappy endings.  And sadly, this administrative layer and insurance layer has proven to be the most destructive and expensive part of the health care industry.  People are set up to be expecting outcomes that may never develop because of the nature of illness and injury; this layer makes promises or at best statements that make for unrealistic beliefs and outcomes. And keep in mind, this layer of health care; administration and insurance operate based on cost instead of what is safe and practical for health care.

Understaffing to cut costs: the single most destructive policy healthcare has embraced. Click To Tweet

tears cryingThe sacrificial lamb presented in closed door board rooms is staffing for the sake of their investors.  Staffing is the largest of health dollars spent so administrators want to curb it. 

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3 Responses to Healing of health care USA: Where are our priorities?

  1. Darmel says:

    I think that the points made here are certainly valid, however, those two contributing factors are not the only reasons that undermine successful healthcare in America. There are numerous other factors aside from the “administrative and insurance layers” that are identified as the causative agents in this malady. A starting point would be to see what healthcare workers, including clinician, administrative, and those on the payer end actually believe are the contributory reasons for our healthcare failures in the USA. The writer brilliantly identifies the various strides that have been made through technological advances and other means. What isn’t clearly pointed out and remains to be identified and explored, are the other causative factors besides staffing cuts, that make this nation that’s the most industrialized country in the world, also the nation with the worst healthcare system in the world. Aye, now there lies the rub in this writers view.

    • Margaret M Helgert says:

      To move this conversation further along I feel much of healthcare issues in this country are mired in governmental and bureaucratic red tape. Insurance administrative costs (Bloomberg Report http://www.bloomberg.com/news/articles/2013-04-10/the-reason-health-care-is-so-expensive-insurance-companies) was close to 19% 20 years ago and according to a most report it is now closer to 30%. “Health-care labor force comprising administrative (as opposed to care delivery) workers has grown 50 percent to constitute more than one of every four health-sector employees” This health care work force includes physicians; physician assistants; nurse practitioners; registered nurses, licensed practical nurses, medical assistants; laboratory employees; radiology employees to name a few. Big hospital corporations are heavy-handed in deciding exactly how many students can be enrolled in many of these programs precisely to keep salaries lowers as attrition rates change.

      So what I see happening is non-healthcare employees and administrators are actually dictating health care on all levels to manage salaries and careers for administrators.

      • To consider all of your excellent points, Meg and Darmel, I would add this. The collective voice of clinicians could be an effective way to identify additional causative factors as well as express clear recommendations of what we need to provide care that consistently meets standards. “I need help with my patient assignment”, “I need more time with my patients”, “We need to have wound care supplies stocked on the unit”, “I need more staff on the unit during peak hours” are examples of nurse, physician, and management recommendations. This actually cycles back to your points about priorities and staffing, Meg and perhaps answering the questions that Darmel suggests would bring in other factors. In my opinion and from a ‘communication’ vantage point, if we were all assertive about such things and were practicing in cultures where listening was also practiced, we could begin to take back or solidify our power.

        Unfortunately, with pervasive bullying, burnout, and emotional risks of speaking up in cultures where it is frowned upon, and sometimes a lack of communication skills, such assertiveness and listening is difficult or impossible.

        For these reasons I see a lack of effective and respectful communication as a core issue too! And the TAIL as they say, IS WAGGING THE DOG.

        I also would add in reflecting on the educational stats in Meg’s reply, that I wonder if schools are more interested in filling enrollment and maybe graduating safe caregivers yet they have little incentive to produce clinicians who also are good at taking care of themselves and thus sustain longterm rewarding careers. So what do alll of these things have in common? Money is key.

What are your thoughts?