It is not an overstatement to say that we live in a time of incredible transformation in health-care delivery. Every day seems to bring a new health-care delivery solution, policy, or startup that challenges basic assumptions about health care in the United States. The health care industry is abuzz with new payment and delivery models and technologies that leave many experts convinced that these approaches will result in better outcomes for patients. I don’t disagree with these sentiments and, as leader of the CareMore Health System, a health-care delivery organization with its own distinctive model, I endorse this view.
While I am encouraged by the amount transformation taking place, I am also concerned that the emphasis on new models of health-care delivery has driven focus away from the essential ingredient of high quality health-care delivery:
talented, thoughtful, compassionate, curious, humble, intrinsically motivated clinicians who consistently work together to exercise sound judgment.
Therefore, given the false choice between ensuring that I have the right processes and technology in place or the right people — doctors, nurses, pharmacists, therapists, technicians, and medical assistants — I would choose the latter every day of the week.
Said another way, any model of health care is only as good as the people who work within it. Health care is a service industry. The services that matter most to patients remain unchanged and are timeless, requiring high levels of clinical acumen and emotional intelligence.
On any given day, clinicians in all care models need to achieve six different but interrelated goals: 1) eliciting information critical to their care that patients may be shy or unwilling to share; 2) understanding and remaining sensitive to how patients’ cultural backgrounds influence their approach to their disease and treatment; 3) communicating with patients about the cause of their frailty; 4) synthesizing a diagnosis and treatment plan from imperfect and complex information sources; 5) motivating a chronically ill patient to make positive changes to his/her lifestyle; 6) and helping patients and their caregivers plan for end-of-life circumstances.
While some of these skills and behaviors can be approximated, and even supported, by novel care models and technologies, most of them are learned over years of schooling and clinical mentorship. Most of these soft clinical skills reflect values and teaching that begins far earlier than one’s entry into a clinical profession.
Some of what I am saying may seem obvious, but a close look at what’s happening within many health-care organizations — both startups and established entities — is that clinical acumen, judgment, and values are assumed; and recruiting organizations focus more on practical considerations such as what shifts a candidate is willing to work; how much vacation they expect; how much money the candidate expects to make; and how many days of call they are willing to take on. Only rarely do they ask someone about his or her perspective on care delivery or personal values. I have fielded many a phone call from health-care recruiters — and interviewed for many a job in health care — and not once did they query my clinical judgment or instincts.