Tuesday, October 16, 2012

From America..with love


The plane touched down on the sun kissed tarmac in Seattle early evening and we were there. A rag tag bunch of clinicians and managers from four organisations and multiple clinical commissioning groups around Hampshire got together in an effort to learn from bits of the US healthcare system, anything to take back, anything we could adapt to the NHS...and before the detractors go up in arms, no, it wasn't about creating an insurance based healthcare. No, this was a trip to Kaiser Permanente, an acclaimed healthcare organisation in the US, this was a trip to Microsoft to see what we could learn as regards IT system, this was billed as a fact finding mission.

And heck, wasn't it just such an eclectic bunch of individuals. In a health economy built on the principle, or at least nowadays, of competition, there were individuals from four different organisations..and politics and mutual suspicion lurked on the back of the minds of some. Organised by the charismatic CEO of one organisation, was this a genuine trip to learn, was this a trip to work together to improve the local health economy...or was it simply an elaborate publicity gig to convince the payors about the benefit of one organisation above other competitors? A grin crossed my face that I knew pretty much all the key players, an advantage of working with all providers..or as one wit put in "working without Walls". My belief that organisations don't matter, the individual passion and drive does..seemed to be borne out in front of my eyes...and it made me smile. Long way travelled...but a satisfying look back is always allowed from time to time, isn't it?

So we toured the states of Seattle and San Francisco. Got dazzled by the technology in Microsoft, stood and looked with awe at the prototypes of IT in development...and most importantly marvelled at the energy and forward thinking of Bill Crounse at Microsoft. Only young folks have energy and understand IT? You had to be there to listen to Bill explaining the use of IT and social media in healthcare with passion and energy.

We went to different healthcare organisations, visited hospitals of Kaiser Permanente...and ended up being very grateful for being asked to be part of this trip. 3 things stood out for me at all the visits, among all the conversations we had, all the queries we had answered.....firstly, the challenges are not dissimilar across the pond and we, in the NHS, have much to be proud of. We do so much more than what our system can provide...and the NHS continues to and probably will continue to survive on the concoction of hard work, sprinkled with passion and commitment, served with dollops of love.
Secondly, an IT system to die for. We ergo the NHS spent billions trying to create an IT system and frankly failed. what we saw was a clinicians dream. It didn't matter where any health care professional worked, it didn't matter who the patient saw, where, how, why...it was all there on ONE IT system. To us in the UK, it sounds like a dream..to the professionals working in San Francisco, it was a way of life.

And finally..the big one. Yes, there were others to learn from ergo how their general practice worked, how they "targeted" the ones with multiple morbidity, gave them more time, had more faith in their community nurses....but the big one was those 2 dirty words..."performance management". Frankly it was amazing to see doctors willing to be measured against predefined criteria. Somehow in the UK we spend more time defending ourselves as doctors rather than accepting that some of us do not serve our patients well. Any criticism of general practice is met by evangelical resistance from Clare Gerada and others. At no point is there acceptance that things may need to change, not all apples are perfect. Same for specialists..we are all doing a "fabulous" job...really? are we? All of us, without exception?? Do please behave!
All health professional maintain direct contact with patients and colleagues via email and are judged on their response time. Someone like me or Jim Hogan who do that as part of their clinical practice are feted as "visionaries"...we win awards for "being there for the patient". No, ladies and gentlemen, what we do is what we all should do, all should adapt as part of their working lives. We do not make the patient bend to our own lives or it's comfort..we do this job as public servants trying to help those who need it. Are we ready for ourselves to be measured against that? 

I asked what happened if people weren't compliant or were failing persistently. "We try reasoning..then we ask them to leave.You can't continue if you are not serving the patient", said the Chief of Medicine with a gentle yet firm smile. And there it was...how many GP or Consultants are even measured, let alone asked to "move on" because they couldn't deliver clinical based outcomes. Walk into a clinic and the performance results of each doctor is visible, public, out there for all to see....we are far, far behind that. We would rather spend time stating how "incredibly hard we all work and how difficult the patients make lives for us...in fact we need more resources"....The NHS continues to carry dead wood.

And finally, the group or the rag tag bunch of folks who started off as organisational representatives. Those "hard ass" Commissioners out to pinch money, those "conniving" competitive providers trying to take us over ,that "scheming" organisation down the motorway daring to challenge our status...all their representatives...over the week..they all became...just..human..and good fun. I am not experienced or knowledgeable enough to pass comments on the organisations...but tell you what..their representatives all burnt with the same passion...to make things better. We laughed, we joked, we drank..and we also sat and mulled over how we can make things work better for the patients in our economy. People slipped out of their organisational shell..John became the "Integrator", the "Ice Queen" just became Sue, Gethin educated us about the joys of singing ( you don't want to know), Derek slipped into the Silver Fox mode, Jenny reminded why Spider-man was nearly my favourite hero, Jim qualified for dad of the decade...and it was just a genuine joy to have been a part of this trip. I learnt a lot about healthcare, I learnt what we could do better...but most importantly I walked away making a lot of similarly minded, passionate friends.

Can we make this all work? Can we battle the tide and have a sustainable health economy? I don't know....but I do know it won't be for lack of trying. Amongst a bunch of folks with drive, foresight and experience, I ran the risk of sitting out like a novice...but like minded folks always find a way to get past that...and so it came to pass.
Mrs Sarti....thank you for the invite..it's been a genuine pleasure and a privilege.Now for the tougher part...to keep those relations going, work together...and somehow...make it happen. Let's give it a try, shall we?


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