MELTED Away Personal and Professional Lives By Health Care Design

We must pay attention and do what we can to reverse MELTED Away. MELTED Away is very personal in impact. Our professional lives are being MELTED Away by others that do not have the same priority on care and caring - the one on one interactions that are the only innovation that matters. We must stop MELTED Away creep as it moves from those most basic in service delivery to those more valued, from those least visible to those more visible, from most Americans most behind up the ladder to American populations that feel the nothingness of being MELTED Away not only by health care but by housing, economics, trade, and other areas.

Teachers have been MELTED Away along with nurses and serving human infrastructure. Almost as MELTED Away is the physical infrastructure. Human and physical infrastructure are focused on relationship, efficiency, and effectiveness. Failure in these key areas results in divisions, divisiveness, and lack of resilience.

Health care is one of the designs that is MELTING Away our nation with twice too much spending taking away our ability to invest in a better future. Military, health care, prison, and debt spending deplete all budgets of the ability to invest in each other.

Stop the Hemorrhage of Health Professionals

The hemorrhages predominantly impact nurses and basic health access team members and other who are valued least and do services paid the least. This usually translates into challenges in the personnel portion of the budget and tough decisions regarding hiring fewer or hiring those less qualified or lesser in training. There is a risk that the newly hired employees will also leave too soon, starting the cycle all over again.

The state, federal, and private insurance "payers" have focused on overutilization and constantly cry out for cost cutting. The Medicare Trustees wail about depleting the funding - resulting in pressures for more cuts. Rarely do they consider the negative impacts on teams and on areas in need of more funding, not less.

The innovators make careers out of their micromanagement prowess which has multiple negative consequences on delivery team members. The micromanagements divert budgets from team member support, and adding more meaningless activities.

MELTED Away consistently impacts nurses and those who deliver basic health access.

• M is for melted away, metrics, micromanagement, more to do
• E is for ever higher in complexity of practice, patient, population, personal life, professional life
• L is for lesser in
• T ime (thank you Diagnosis Related Groups) and in Team member numbers, team member training experience continuity...
• E is for Ever more disruptive with impacts on personal and professional lives and causing moral injury disruption
• D is for Disruptive - Disruptions of relationships prevent the only innovation that matters one on one with each patient. finances, practice environments, situations, relationships are all disrupted by design.

My take on social determinants and non-clinical factors that predominantly shape outcomes is that what can be done by delivery team members is relatively small in terms of changing outcomes. What they can do is about relationship, continuity in specialty, continuity in the same practice with the same team, learning with the same patients and in the same community. I see 40 years of designs disrupting all that primary care was and hopes to be. The NOTHINGNESS is winning as is moral injury, burnout, high turnover, turnover costs - with all acting to steadily decline primary care from the financial design outside to the core values inside.

Cheaper and lower in value is how nursing and basic health access team members are treated. Designers continue melting hopes and dreams with there MELTED Away designs. From their perspective this makes sense, apparently. But our inside out perspective leads to a different conclusion. We will not tolerate compromises of what we are as human beings.

We must not let them

• Melt us as people and professionals
• Melt the patients that we serve
• Melt the populations that need us
• Melt our basic services which are made too complicated or are denied by design
• Melt the poor and the elderly and disabled - which CMS is supposed to serve
• Melt health care in counties with concentrations of poor, elderly, and disabled as the public plans do not pull their weight and the private plans are too weak to overcome public plan deficits by design

There are two main venues of melted away.

• Profit focus
• Survival focus

Both result in diversions of the budget to maximize profit or to survive for another year.

Health care designs force choices that cut personnel budgets and shape fewer of us or lesser of us, or both.

Their inability to visualize from the inside out or their willingness to ignore us has consequences.

THEY ARE CUTTING THE Heart out of health care delivery. They are harming the only innovation that matters - one on one with each patient. They also harm care, caring, health equity, jobs, economics, leadership locally and more.

Thou shall not kill nurses and others working in hospitals by cost cutting, profit focus, survival focus, or too much to do too fast and with less and less support.

Thou shall not kill hundreds of hospitals and countless practices across primary care, mental health, women's health, basic surgical, and geriatrics where the United States is growing fastest in numbers, demand, complexity, elderly, poor, disabled, chronically ill, mentally ill, diabetics, lower literacy levels, lesser social supports, and weakest employers.

The blue line arises from the combined rural and urban population in the 2621 counties lowest in health care workforce with 40% of the population in 2010. The fastest increasing red line is the urban component of this 2621 and the turquoise line is the rural component about 40 million and holding. More millions must make choices to address higher costs of living and deficits of available housing in counties with concentrations - and this puts more strain on the counties lowest in resources, health care dollars, workforce, and supports. I cannot imagine how bad it is becoming for caregivers given these steady deteriorations by design.

In green are the middle concentration counties also with substantial growth compared to Higher (purple) and Top Concentration (orange) counties.

This summary slide demonstrates that best of times for those in concentrations and worst of times where they ignore what is going on. The 1980s and early 1990s set these designs in concrete, making them difficult to change. Most Americans were set behind only to be made worse - by design.

Foundations talk about community leadership, but fail to recognize that health care designs shrink this important component.

Government jobs, education jobs, health care jobs, better insurance plans, and leaders are cut or centralized away from these 2621 counties. This is numerous pathways of decline by design.

Designers are cutting the heart out of health care and the heart out of community life - by design. Agriculture employment continues to fall. Trade policies betray these counties. Environmental policies complicate mining. Outside ownership makes it difficult to focus inside out on what these counties must have. Abuses will continue until those who lead the nation understand these Americans and their situations and needs.