3 humble observations

Over the past several years, I've had the “opportunity” to gain firsthand insight across a diverse range of inpatient and outpatient settings. This includes various hospital systems, the Veterans Administration inpatient and outpatient settings, as well as long-term care and rehab facilities, along with their subsequent transitions of care. It strikes me that this concentrated breadth of experiences as a consumer, combined with over 30 years on the business side of healthcare, might be somewhat unique. With that in mind, I humbly offer these three observations, aiming to spark dialogue and with the hope that dialogue may lead to pragmatic solutions.

Observation #1: Patients’ Care Expectations are a constant.? Actual results will vary.

The prospect of being admitted to a hospital is inherently anxiety-inducing, potentially signaling something significant, very personal, or even existential, is not right. ? Despite patients’ care expectations being a constant, the reality varies widely across different care settings and systems.

While my experiences have primarily been within Minnesota's health systems (including Mercy Hospital, United Hospital, Regions Hospital, Abbott Northwestern Hospital, Mayo Clinic Hospital, and the Minneapolis Veterans Administration system, alongside numerous long-term care/rehab facilities), the variability in experiences even within a state with presumably high-quality standards is striking. Some facilities excel, yet I can't help but wonder how exceptional these experiences truly are without contrasting them against instances of what I consider to be substandard care.

Observation #2: Nursing matters.? It matters a lot.

In my experiences, the caliber of nursing within a care system serves as the bedrock upon which overall care quality rests. Exceptional nursing not only enhances patient experiences and outcomes but also reflects positively on all facets of care provision, and can be a barometer for overall system quality, from food service to physicians.? It is shocking when encountering substandard nursing care, such as my recent experience in an LTC/Rehab facility where a friend’s critical situation was neglected.? The outcome of his episode depended primarily on luck. I just happened to be there to demand attention.? Had it been left to that facility’s standard of nursing care, the outcome could have been tragic.? It underscores the profound impact of nursing on patient outcomes.

It's noteworthy that individual dedication is relied upon at times to mitigate systemic shortcomings, as evidenced by my observations within the VA system, where the quality of care varied significantly based on the heroics of the individual personnel involved. I found this to be the case with both my parents receiving the bulk of their care there.? Their outcomes were materially impacted by this variation.? Again, their care really depended on luck. Who were their nurses that day?? Who were their physicians? Who were their other care-givers?

Fortunately, I’ve also experienced consistently excellent nursing, as exemplified by the Mayo Clinic's St. Mary's Hospital.? The nurses there reliably and consistently demonstrate the transformative power of a culture committed to holistic patient care. Individual effort is also notable. Rochelle, Alyssa, Anita, Michelle, Nick, Dean, David, Sao, and the many others who cared for my family member in his almost 2-week admission were outstanding.? I was humbled by their skill but more so by their dedication to their patients. They took the time to get to know their patients on a personal level - chatting them up when they had any opportunity, taking them for walks (or wheelchair rides) when they could, treating them with the dignity and respect they deserved.? Not once did a call button receive a response in over 2 minutes.?

Nursing and working on the front lines of healthcare is hard - even at the Mayo Clinic.? (see recent StarTribune article here:? https://www.startribune.com/mayo-clinic-faces-worker-distress-as-employees-bargain-unionize/600372036/)? While there may be an element of that regardless of the system involved, when it’s done well, it matters.?

Observation #3: Physicians, know thy patient

During our recent experience at Mayo, I came to find that if I wanted to speak to a physician, I had to be in my family member’s room for literally 18 hours each day.? I discovered rounds usually occurred between 6 and 6:45 am each day.? Keep in mind, this is the Mayo Clinic in Rochester, MN.? Like the vast majority of patients and family members there, I don’t live in Rochester.? Speaking to a physician meant either a lengthy hotel stay or getting up and on the road by 4:30 each morning so I could be there in time for rounds and the 5 minutes we might spend with the residents that day.? Hospitals, even the Mayo Clinic to whom I will be forever indebted for their outstanding care, are not built around patients and their families.?

Effective communication and patient involvement in care decisions remain major challenges. The hierarchical nature of decision-making, coupled with limited patient-physician interaction, underscores the need for strong patient advocacy.? In our case that meant all decisions were made by the surgeon (who I saw a total of one time during our almost 2 weeks) with his decisions flowing down from there and with the patient being at the bottom of the communication loop.??

I will carry my personal experiences with family members falling victim to preventable medical lapses in other, non-Mayo care systems forever.? They emphasize the critical role of patient advocacy in navigating complex healthcare systems. Patients must assertively participate in medical decisions and have a support network to advocate on their behalf.? Lapses in care can happen anywhere.? Care teams are working from partial information and data at best? making it particularly important to actively participate as an equal part of the care team.

While my reflections may appear critical, they're not intended that way.? I certainly don't intend to condemn or promote any one setting or profession versus others. To state the obvious, it is complex. As someone deeply entrenched in the healthcare industry, I acknowledge my responsibility in addressing these systemic issues. Despite the inherent complexities, I remain optimistic about our capacity for meaningful progress, fueled by the ingenuity, dedication, and technological advancements within our healthcare community.

I’d love your thoughts.