Recently, I wrote a blog about Mom’s hospital stay. I wrote it from the perspective of a family caregiver and addressed it directly to the hospital. Now my sister Melinda, a nurse practitioner, has written a guest blog from the perspective of a healthcare provider to Healthcare Provider. She makes important points for all those in the medical field. I am happy to share my space with her.
Dear Healthcare Provider,
You were inspired to join this profession to serve others. You hoped to make a difference, to heal the sick, and preserve life. You started out with a strong drive and sense of purpose. You showed compassion and empathy to those in your care. I know because I am one of you. Ours is a noble profession that is struggling to keep up with the demands of our aging population.
However, in this noble profession, there are major problems within the structure of how the system operates. In a profession with such enormous responsibility of managing disease states and restoring health to the masses, errors, lack of quality, and soaring costs have been identified as a major issue. Sweeping reform has begun.
As a healthcare provider, you are alarmed at these findings. Change must occur. You must do better. But you are working so hard…long hours, nights, weekends, and holidays all while caring for more and more complex patients. You spend countless hours trying to remain on top of your game. You are reading endless journals, going to conferences, participating in research, and learning technologies in the few spare moments that you have available. Time is short for all that is expected of you. Yet, sweeping reform has begun.
Laws have been passed. Timeframes established. Technologies added. More expectations placed. But there are still only 24 hours in a day and this fact will never change. We cannot make more time in the day. You grow weary of the changes. Out of sheer fatigue, you begin resorting to just checking the boxes which are now required. Based on mandates passed down from reform, the hospital is now driving the need for meeting deadlines, checking boxes, and documenting a certain way. This has become your new reality. Terms like meaningful use, bundled payments, accountable care organization, new EMR criteria, new CPOE order sets, 30-day readmission, 90-day readmission and patient portal access swirl around in your head day and night. Why? Because reimbursement is tied to this new technology. You find yourself fixed more and more on the computer screen and less and less on the patient. The simple skill of observation has become lost in the technology use required of you. Yet, sweeping change continues.
Healthcare Provider, please don’t misunderstand. The goals of sweeping reform are as noble as the profession you have chosen. But the enactment of the reform, remains a struggle. Process change is hard. Most change is being driven by those who are reviewing the data on failures/shortcomings, and then creating new processes. However, they are not collaborating with those who are in the trenches within the walls of the healthcare system caring for the sick.
Many will say, “Healthcare Provider, if you don’t like the changes then be part of the group creating the change. Step up and be the solution”. You agree that this is important, but at the end of your day, after doing your best in the broken system, you find yourself with little energy left to commit to even an important cause. There are a few of you who still manage to meet the new criteria placed on you while still maintaining your sense of responsibility to spend time with your patients, observing, assessing and listening to their story of disease and illness. You still find compassion for the patient and empathy for what they are facing. But this, Healthcare Provider, is becoming less and less prevalent in the changing system.
Isn’t it interesting, Healthcare Provider, that this sweeping reform is stated to be about increasing value? It is advertised as a value over volume, pay for performance model. How can data measure value? Oh, they will find a way… you know it is true. Value will be based on numbers of falls, medication errors, adverse events and/or sentinel events. It will be based on appropriate hospitalizations and readmission rates. It will be based on patient perception of their experience, i.e. how they complete a survey.
As a fellow healthcare provider of 32 years, I feel the tremendous burden you bear. I bear it with you, daily. However, I recently saw the system from the other side. If you have not done so, please read my sister’s blog Dear Hospital. I cannot explain the feeling of being the family member of a patient with complex needs any better than she does in her letter. I will not even try, but it inspired me to write my own blog from a professional perspective. However, I can tell you that I, as veteran healthcare provider, was right there. I had so much to offer on behalf of my mother who can no longer tell her story due to dementia. I tried, repeatedly, for 36 hours to tell her story, to help you investigate, to help you understand what our needs were in regard to this hospitalization. I was there to guide you with knowledge and understanding of her condition which even you did not have, Healthcare Provider. I have researched, learned, and reached out for many resources since my sweet mother received the devastating diagnosis of Frontotemporal Dementia (FTD). You have not had time in your busy work life to do this type of research. I can assure you that unless this is your specific specialty, I understand and know FTD better than you do. I am living it, daily, with my aging parents as a family caregiver.
With each attempt, no one took me up on my offer. No one slowed down and really listened. I saw the adverse events of over medicating my 80 year-old mother. I saw quick response with oxygen and fluids being added once this adverse event was recognized, but as recovery was gained, I had to question why the O2 was being continued. I had to question why 100 ml per hour of IV fluid was continuing even though her BP recovered and she was taking clear liquids well. I had to question why they still had my mother on bedrest. The answer, ”We thought this was her based line.” What???? Baseline??? I have been right here with her the whole hospitalization, and somehow from shift to shift no information was communicated appropriately. She is not on O2 at home. She walks independently (though slowly, mind you). She eats normal food (all by herself). She has caregivers and my dad with her 24/7. The reason for this is she has lost her executive function. Healthcare Provider, slow down and think. Do you understand the impact of no executive function? She cannot process information and/or instructions well. It takes constant supervision and breaking down ALL tasks into very small incremental steps and reinforcing those steps CONSTANTLY, day in and day out.
So, as the sweeping reform continues, please remember Healthcare Provider, we need you to step away from the computer screen and care for us…see us, talk to us, and ask questions of us. Once armed with information, assessment findings, and test results, we need you to collaborate with other providers who are on the team caring for us. We need you to communicate as a team. Then we need you to include us in making a plan of care that makes sense for our individual situation. We need communication. We need presence. Your presence. Because you are what makes the difference.