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Every time I turn on the television, go to a book store or see a movie advertisement I see "ZOMBIES." Zombies are everywhere. (Even the Centers for Disease Control and Prevention got into the action with its Zombie attack preparedness manual.)
Now I love zombie movies as much as anyone. In fact, "Shaun of the Dead" is one of my favorites, truly illustrating an existentialist view of life where people operate on autopilot.
After my most recent visit to the bookstore and the most recent zombie reminder, I got to thinking about people operating on autopilot. I have heard on many occasions from physicians and nurses alike that the traditional medical model--with the clinical guideline adherence; the relative value unit generation requirement; the constant goal of "fill in the box on the EMR," determine diagnosis, prescribe and get to the next patient as quickly as possible--contributes to the feeling of "practicing on autopilot" with little connection to self and/or patient (a zombie-like trance).
It's not that they don't want the connection. In fact, they share that they are desperate for the bond and long to reconnect with why they became healers in the first place.
Interestingly, being on autopilot is not restricted to only practitioners in healthcare. In a recent conversation with a public health official (an administrator) I heard the following: "I don't have time to think. I only have time to do. I have so much to do that even the thought of taking a moment to breathe and think about what I am doing, why I am doing it, and how to do it better ... just couldn't happen." Now this individual is a passionate, creative, caring person whose greatest gifts are being lost to the system as she transforms into a zombie-like state in an effort to "get things done."
In this same realm, a well-connected consultant was discussing quality of care with a CEO of a large hospital (who also happened to be a physician). The CEO discussed pressures--financial pressures--and responded to a question about improving care quality with the following: "Quality improvement focused on quality of care? I don't have time to focus on quality of care. I need to focus on improving efficiencies and revenue generation if I am to keep my hospital open. That is my focus. Care quality must take a backseat for now."
Care quality taking a backseat to fiscal pressures? It's another example of a caring, passionate, mission-driven healer/administrator being transformed by the broken healthcare system (with its misaligned financial drivers and intentions) into a zombie-like state with a limited focus on the bottom-line.
I also was fortunate to have coffee recently with a brilliant health IT consultant who shared the following story with me: "I had decided that the next primary care physician I selected must use an electronic medical record. I believed that optimal care would best be supported by a physician accessing an EMR. I made my new selection recently and went in for my initial visit. My new doctor had access to a plethora of my historical data. He could have seen trends in my blood pressure. He could have seen my prescription history, correlated what had a positive impact with what did not, and much more. But he did none of it. He did not have time. He asked me a couple of questions, he filled in the EMR boxes, and I was on my way. We had little discussion, little connection. The EMR had little positive impact. Now I have rethought my selection criteria and will find a physician who will connect with ME not only with the EMR." Another physician on autopilot?
Can physicians in zombie-like states best position patients for optimal healing and patient safety? Can healthcare administrators showing zombie-like tendencies best position clinicians to provide optimal care and safety?
My evidence? Look at the patients who are being harmed by the system. Look at the adverse events and errors in care provision. Autopilot does not work.
As I began to write this post I happened upon a blog titled: "Heroes Not Zombies." To my pleasant surprise rather than reading about "brain eaters" I saw the blog post "The importance of the doctor patient relationship." According the post, "Relationships are fundamental to happiness. And so a science that has the courage to include the doctor's relationship with the patient within the treatment itself, and to work with it, is a science already modeling the solution it prescribes."
The healthcare system must change.
The healing encounter must evolve to include optimal time for connection, relationship, trust, empathy and must do so in conjunction with quality improvement, optimal technology and care systems all being best leveraged to improve care (not predominantly for revenue generation).
Practitioners must be allowed to turn off the autopilot switch, reconnect with themselves, their passion for healing, their patients, and the reason they became healers in the first place.
And us administrators, we also must reconnect with ourselves, our passions, the reason we got into healthcare ... and if we determine we are here for any reason other than improving the health and lives of our friends, our neighbors, our families and our communities, then we ought to move on.
It is time to stem the tide of the healthcare zombie epidemic. Are you ready?
Thomas H. Dahlborg, M.S.M., is Vice President for Strategy and Project Director for the National Initiative for Children's Healthcare Quality (NICHQ), where he focuses on improving child health and well-being. He has 23 years of experience leading collaboratively, creating optimal healing environments, analyzing and addressing practitioner and patient needs, and developing and implementing aligned strategic plans.
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