Below the Surface of Coordinated Care – it All Starts in the Basement!

Andrew Slotnick

My wife is a nurse, I am a marketer and between us we are approaching 20 years of cumulative healthcare experience ranging from pharmaceuticals to devices to HCIT to nursing. Therefore, it should come as no surprise that a day rarely goes by that we don’t find ourselves deep in conversation involving one area for improvement within healthcare or another.

Last night’s discussion focused on a heated exchange that Lisa had had earlier in the day with a security guard. This was a bad sign for the security guard I thought because Lisa only gets really upset when she is both passionate about something and is also right. The situation was that she was discharging a patient from the general medicine floor that she works on at a well-known Boston area hospital, who had left some money in the care of hospital security and needed it back. The security guard told Lisa that it was the patient’s responsibility to come down and pick up his money – the two spent nearly five minutes butting heads.

On the surface this situation could even be portrayed as a humorous. Big mean security guard bullies sweet little nurse because it’s just so darn boring down in the basement and because it’s fun to get a rise out of the nurses. It’s not funny actually and until we look below the surface, and break down interactions like the one Lisa had with security the concept of coordinated care will be what people are laughing at.

Don’t worry; I am not suggesting that the security guard be involved in planning patient care. What I am suggesting though, is that reimbursements in an outcomes based world will depend on complete coordination, which means everybody who interacts with the patient must be aligned. Conversations like Lisa’s happen thousands of times a day in hospitals all across the world and yet we wonder why Healthcare Associated Infections are costing our healthcare system upwards of $45 billion dollars[i] a year, or that 30-day hospital readmissions rates are pushing 25%. [ii]

The security guard caved. He brought the money up from the basement, 7 floors and a long hallway away, to the patient, and the patient was sent home. The patient was sent home because he had been put on hospice and wanted to be at home. If the phone call between the nurse and the security guard had turned out differently, the patient may never have left that hospital.

It doesn’t take R&D, clinical trials or double blind placebo controlled studies to realize the benefits of coordinated care in situations like the one I described. Recognizing that simple actions have significant consequences is the foundation of coordinated care, but at times seeing through the day to day and outdated procedures can be difficult. So weather your safeguarding money in the basement or mapping out informatics and IT solutions in the C-Suite – enable those around you to keep patients at the center of each decision, reward patient centered decision making and remember the big picture.

[1] http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf

[1] http://www.chqpr.org/readmissions.html

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