Comments

We need you more than ever in healthcare Tom.

Chief Executive Officer of the NHS in Britain would be a good job for you but I guess you couldn’t afford the pay cut :-)

Please keep rattling the cage - as a starter it would be great to see all Chief Executives in healthcare 'bagging' at the front line of healthcare alongside the nurses and doctors (like the store manager you saw today) The reality is many CEO's in healthcare come from a Finance background - which is an immediate giveaway - and most of them don’t meet a patient (or the patient’s family carers) from one decade to the next – and therein is the fundamental problem. They spend their time working on financial projections with spreadsheets that no one else understands - ‘bagging’ on the front line is definitely out of bounds :-)

But we must keep trying to correct the error of their ways.

Posted by Trevor Gay at March 24, 2008 1:00 PM

Tom

I too am working on Health Care - I have spent the best part of the last 2 years developing some simple ways to dramatically cut the cost while improving the outcomes for patients.

Health Care could and should be better than ever in our history. Why isn't it? A simple question with a simple answer. Health Care is oh so badly organised.

Health Care is run essentially as a business in the US and yet it is run by people who are risk averse and power freaks - yeah I mean Doctors.

Health Care in the UK is run as a 'universal coverage' public service which is taxpayer funded. It is run by risk adverse bureaucrats who are also power freaks - some use to be Doctors.

In my country, Australia, we have a mixture of both systems - yeah the worst of both worlds.

Recently I had a accident and so I had a personal opportunity to test our Health Care System at all levels of its operations. One-on-one the carers, Doctors, and administration staff could not be faulted - in our case they are a multi-national workforce with a common language (they all speak English to varying degrees) and with those huge hearts you might expect from carers.

The problem with our Health Care is not the people but the system. The system is antiquated - for example I saw and experienced a hugely inefficient people-based system (with paper based files) where modern information technologies should prevail. There should be fewer people in our Health Care Service but to achieve that outcome the patient must become the hub of system not the Doctors.

The patient has to be more informed and become an active part of the decision-making about his or her health care outcomes. Health Care has to become more a self-service system - when it is set up that way it will cost less and deliver better outcomes.

Tom, we both know, that not all patient are capable or self-serving - so relatives might have to step in as 'patient advocates' to fill the vacuum. Where that can not occur then a full service system has to operate - again Tom as you know regrettably these patients face a higher risk of bad outcomes, of rework ( procedures having to be redone, etc) and even death. Why? Again the answer is simple - when the patient is not an active part of the decision making process then the risk averse, cover your backside, hide behind procedures, etc approach to health care is delivered to you.

In my recent and currently ongoing episode with our Health Care Service I am my own advocate! When I went into hospital I was strong and so I challenged everyone on every procedure and every bit of medication. I refused most medications! I refused the normal procedure unless or until I was fully satisfied that I had exhausted all the options. I ended up being briefed on everything in the same thorough manner I use to brief my Prime Minister (many many moon ago) before he took a big decision - but here I was the Prime Minister and the Doctor was my adviser.

I am getting well again because I had a very good outcome from a Health Care System that is both brilliant and sucks!

For me Health Care is the number one Challenge in 2008 at the political level, the community level, and most of all at the Patient:Doctor level.

Thanks for raising this issue Tom!

Richard.

Posted by Richard Lipscombe at March 24, 2008 6:26 PM

Hi Richard

Brilliant comments and you are absolutely spot on as I would expect of course :-)

Your experience as a patient is typical of most patients – the 1 to 1 care is superb and there are thousands of totally dedicated, professionals and caring front line staff trying so hard to deliver care whist being frustrated by unnecessary paperwork and process. You are also right about the need to see universal electronic patient records and you know that is one of my current passions.

Giving more power to the patient is hugely important so that there is real partnership with the clinician and not a world where the patient is merely a passive recipient of care from the aloof ‘expert.’ We have a project in the UK called the Expert Patient Programme which is all about developing a true partnership of equals between patient and clinician – it is fabulous and has great potential.

Healthcare is the number one priority as always for me in 2008 and until I die I guess. It is brilliant that people like you Richard with all your experience at the top levels of government and Tom Peters are rattling the same cage – we all want patients to receive a better deal – there can be no higher or simpler purpose surely.

My personal view about the future of healthcare is all about the challenge of execution - as Tom has been passionately promoting recently.

It’s about time we sorted out healthcare. We have a vested interest for ourselves, our children and our grandchildren. Succeeding generations will never forgive us if we don’t sort this out with all the tools and information now at our disposal.

Posted by Trevor Gay at March 25, 2008 6:34 AM

Hey Tom - be careful! Books like these are great examples of why we should have national healthcare! :-)

I have experiance with the VA system and are so far pleased with it. What you quoted was correct. I am a diabetic on insulin and the VA provides testing equipment, the strips for the equipment (quite an expense), and the insulin needles free of charge. Why? Because the strips are so expensive that I would not test enough giving me poor control, leading to further complications that the health care system would have to deal with. Free of charge and I have no excuse not to test and, of course, I will have less complications and less for the health care system to deal with. This logic fails the private health care plan I am on.

Also, I have had to go to two VA sites to obtain medical services. A bit of an inconvience but, amazingly, both sites were tied into the same patient database and had the most current information on me. That system is great!

It is a shame that the facilities are many times in poor repair and sometimes not up to date. I suspect this has to do with budgetary constraints. Lots of times, that is all that the public hears about the VA. A perfect system? No - but then which one is?

Posted by Al at March 25, 2008 10:50 AM

Tom: Thanks for recognizing the VA in healthcare, I believe it may be the most understated benefit of our veterans.

Is VA healthcare great? Yes, Yes and Yes again. My 82 year old father is a WWII and Korean War Vet that served as a Marine in Iwo Jima, Guadalcanal and was part of the Chosin Reservoir campaign that led to frostbite of his feet. That frostbite eventually led to skin cancer that he had had to have numerous treatments. Since being declared partially disabled by the VA, he has had full healthcare coverage. Late last summer, my father fell and broke one vertebrae in his back and was taken to the local VA hospital. At first I was skeptical of the care and competence of the doctors, but that soon changed after a few days in the hospital. I could go into an account of the care, surgery, and recovery; but, suffice to say it was top notch. Think that doctors' house calls are extinct? It's not in the VA.

However, the amazing part of this story concerns his asthma, which he has suffered through for most of his adult life. My father has been to specialist after specialist with no real improvement. Once he became a patient of the VA, they fully analyzed his asthma medications and treatments. This led to a change in his medication, and I believe a personally designed formulation, which now has greatly reduced his asthma attacks and has improved his overall breathing.

It's funny that when VA care is brought up, it is usually assumed to be poor. Our family is convinced otherwise, and my father can vouch for that!

By the way, our local VA hospital just started a free Valet parking service for visitors. How's that for serving the patient and the family?

Kudos to the VA!

Posted by Barry at March 25, 2008 11:21 AM

I am a veteran. I agree the treatment I recieved and continue to recieve at the VA medical center in Temple, Texas is better then the Darnell medical Center on Fort Hood. I would imagine the time and dedication put in to the 'customer service' has a lot to do with the quality of work at a VA level of medical center. Most of the 'foot' work are retired and veterans themselves, where as other medical centers (even the Army ones) are more on the numbers. So I will continue to use my given rights to the VA centers across this great nation.
With a mind like yours Tom I am sure there are a few rocks that have not been turned- it sometimes takes an outside look to see the roughness and the 'how' on the fixing part too.
Respectfully,
Jennie B. Killeen, Texas

Posted by Jennie at March 25, 2008 5:41 PM

Thank you so much, Jeannie, for your service.

My dad was also a veteran. Unfortunately, he passed in 1989 after visiting a VA hospital for a routine check-up. He had not been feeling particularly well. While there was a benign prostate condition, they injected him with a dye to discover the root problem. He began feeling worst and went back to the VA hospital several times after the injection.

He was allergic to the dye and apparently the process, as the VA doctors then determined, could not be rectified; my beautiful dad was sent home after making two trips back to the hospital when he was not feeling well. Both times he was sent home. We found out about my dad's condition at 2:00 am the very morning of his passing, as he literally breathlessly phoned my mom to tell her what had happened. He had apparently been in critical condition since the injection.

Our service men and women most certainly need the very best care and service, as we are so grateful for yours. I honor you this day and wish the very best for you and yours.

Posted by Judith Ellis at March 26, 2008 1:21 PM

So, Richard Lipscombe, you're an Aussie? Great! I lived in the Outback, Mt. Isa to be specific, for nine months. While there I did a fare amount of traveling. Australia is a really beautiful county. Syndey is one of my favorite places.

Posted by Judith Ellis at March 26, 2008 1:32 PM

Mr. Peters:

"Instead, I am interested in why we spend so much money, and yet trail Bosnia in life expectancy. (Our rank: 45.)"

The CIA gathers, but does not generate these statistics, they simply take what some reasonable authority (like the country's government) publishes and go with that.

The problem is that there are many different ways of determining "life expectancy". As an example in the United States (as I understand it, it's been a decade since I was in the health care industry as a worker) we classify any baby born with a beating heart and brainwaves as a "live birth", even if they die before they get to the warming table. Other countries (IIRC the Netherlands) don't count it as a live birth for statistical purposes until 24 hours have passed. When you put lots of zeros into an average it tends to slant it down, no?

Another way--does their government count people killed in war or violence against the life expectancy? I don't know of any country who leaves out those sorts of deaths, but one could make the argument that soldiers killed in war shouldn't count against the life expectancy of the general public.

A final example is from outside the health care field, barely. In the US if someone kills you and it's NOT cleared as self-defense or something similar it's counted as a homicide. In England for it to be counted as a homicide the case has to be solved. So even if the number of murders each year were identical, England would always have a lower murder rate because there would always be one or two that weren't solved.

I don't know who said it, but "Figures don't lie, but Liars can figure."

Then again I'd bet the average Bosnian doesn't eat a bag of Frito's a week.

There are a lot of problems with the Health Care system in this country, but the largest problem is with the patients and the government. Patients want to sit on the sofa and watch soft core porn on the television while stuffing all manner of garbage in their cake-holes and then show up at the ER in cardiac arrest and have the surgeon give them a pill to make it go away.

On the other end of the spectrum we've got guys doing insane levels of exercise for no reason other than testosterone, wearing out hearts, knees and hips, and showing up at "their" doctors for treatment.

It's easy to blame the doctors and Big Pharma.

It's hard to eat right and get the right amount of exercise, and it's doubly hard when you've got a political class that suggests that if you just whine hard enough they'll fix it.

Bah.

Posted by Petro at March 28, 2008 1:09 AM

The cause of these problems are simple, fundamental, and easy to understand, but solving these problems are next to impossible as long as Americans lack the will to deal directly with the underlying issues:

1) You are all dying young because you are fat. Ridiculously fat. Bizarrely fat. Every time I go stateside it's like being in some sort of carnival freakshow hall of mirrors. The USA is the only country in the world where a major famine would actually reduce the number of people dying from malnutrition.

2) You pay stupid money for healthcare because of private insurance. A bunch of parasites have inserted themselves between the patients and the doctors. They are expensive and unnecessary for delivering healthcare.

Solving these problems is a lot more difficult than defining them. Americans aren’t going to stop gorging themselves to death any time soon (the food industry will see to that), and the insurance companies will fight tooth and nail to preserve their golden goose. The key point is to treat these problems as fundamental. You aren’t going to make any meaningful progress through the continuous improvement route. Radical overhaul is necessary.

Posted by JG at March 29, 2008 8:42 AM

WOW!!!...JG...how did I miss your comment? Thank you for its truthfulness that rings throughout. Are there not similiar problems in your part of the world? While I am not inherently opposed to big business, I think that there needs to be constant overhaul.

Big industralized nations, have typically hewn big industries. To a large degree these nations and industries may have similar issues in that largess includes consumption on all levels. And where there is not am exit there is backup. This is not healthy, physically or psychologically.

There is the mind and body to consider, not only physically and psychologically, but nationally and internationally too. How do the way we live affect not only ourselves and our surroundings, but others?

Posted by Judith Ellis at April 5, 2008 10:07 AM