In Atul Gawande's Ted Talk: How do we heal medicine, he discusses the transformation of health care and the ways in which we can begin to fix a broken system. Today our deepest crisis of medicine, is the cost of health care globally. We have gone from pre-penicillin days (1937) in which medicine was very cheap yet ineffective, to today where we have treatments for nearly all conditions. The foundation of medicine and doctors has been to be independent, self sufficient, and autonomous. However, self sufficiency has become a disaster for medicine. Gawande notes in his talk that 2 million people come into hospitals and pickup and infection they didn't have, all because someone failed to follow basic hygiene practices. He goes on to say that the most successful hospitals in giving treatment to patients are ones that look like systems.
He highlights three key points that systems allow. First they have the ability to find where successes and failures are, second they devise solutions, and third they have the ability to implement. The key point that Gawande discusses is through devising solutions. In medical care, his solution is to have checklists, like other high risk industries do (ex. aviation world). These are tools to help make experts better. After implementing checklists in 8 different countries, ranging from rural to urban areas, complication rates fell 35% and death rates fell 47% in every hospital. The implications of this information is huge for the medical world. By implementing something this simple, it allows for hospitals and medical staffs to work more cohesively together and give more successful treatment.
This Ted Talk made me think of the ways in which going into my practice experience, how gaps could occur with staff and patients. By creating more of a system, although requires people to embrace a different set of values from the foundation medicine has grown on, medicine can be more successful and perhaps in the long run less expensive.
http://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine#t-1136248
I liked what you said about standardization and checklists, and that implementing standards can make quality of care so much more effective. I definitely think that one problem of healthcare treatment is lack of regulation in some areas. For example, I've heard that companies that produce medical devices are inflating the cost of healthcare in the United States. The companies are profiting off of the devices because there's market competition, and hospitals are forced to buy at potentially inflated prices due to no regulation. In some European countries they standardize medical devices and hospitals only buy from one medical device company annually, and from the company that offers them the best price. I think this issue is making health care more expensive for every one. Maybe implementing standards would help this issue
ReplyDeleteThanks for the post, Rosa. I found this particularly interesting because the issue closely bisects with those experienced in Tanzania. Upon doing my literature review research, I realized that much of the inefficiencies in systems are due to 1) a lack of national resources, 2) lack of community participation in resource prioritizing, and 3) a lack of sufficient resources and oversight in the different tiers of health service centers. The lack of funds available to oversee these centers results in decreased moral to follow guidelines. The upstream factors are all tied in to the change in behavior and correspondence to policies/requirements. How can we fix this both in the United States and in other countries? That's a whole different matter.
ReplyDeleteI definitely agree with the TEDtalk. Even in the nonprofit world, in order to have effective outcomes, one needs standards to match or exceed. Those standards will not only make quality of life better, but also more equal between persons. The lack of standards causes inequity between different organizations and practices. However, adding a set of standards requires a system of accountability, structure, and financial resources. To have standards, there also has to be a community need for them, which is hard for low-income populations, especially when it is not their priority.
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