6.8.08

This Summer's Blockbuster = Mission Impossible: Reaching for Perfect 10s in Healthcare

NYTimes Quotation of the Day (8.6.08):

"How could they take away this beautiful, this most perfect thing from us, the one thing that separated our sport from the others?"
- Bela Karolyi, a longtime coach, on the dropping of 10.0 as the top score in Olympic gymnastics

First, a disclaimer. I've been watching entirely too many superhero movies this summer, and all the Olympic coverage has me sickly preconditioned to break out into spontaneous cheering at any time (ahh, but do I cheer for the Netherlands, the US, or both?!)

Luckily, the healthcare industry is in such desperate need of a global makeover that you can cross-pollinate creative metaphors for change from just about anywhere. So away we go.

Maxims and metrics that hold true for one industry often hold true for others.

You can't get a perfect score in gymnastics anymore. That's probably a good thing, especially if one of the most famous coaches of all time believes the opportunity to be 'perfect' is the only distinctive thing about the discipline.

But hospitals, doctors are regularly expected to hand-deliver 'perfect 10s,' at least during inpatient hospital treatment, resulting in never-events that will no longer be covered by CMS (Medicare/Medicaid).

Now, I'm all for the pursuit of perfection.


I've occasionally turned down a project because I didn't think I could complete it at anywhere near my normal level of energy and drive. I'm young, still malleable, still testing my horsepower, and largely (although not hopelessly) optimistic.

I've reached the point with work where if I'm not passionate about an initiative, overdrive-engaged in a cause, devoted to achieving a certain effect, I try not to take on the assignment. It's exhausting, yes, mostly in a good way.

When I lose my excitement for the job, it'll be time to switch gears. Old I'll accept gracefully, tired no way. That hasn't happened yet. But I still say yes too often. I'm still looking for the perfect 10.

I should say no more often, for this very reason. Or at least accept the fact that I'll reach peak energy for about 3 months and then go through trough periods of near burnout (3-7 days). I'm no Olympian, and I do myself and others a disservice by copping to that perspective.

I'm trying to deflect a strong dose of that perfectionism towards being a better team player. If I can't serve the cause, however, I'm happy to connect other star athletes and help A-teams go for the gold.

Healthcare is definitely an ego-centric, OCD friendly-three ring circus (hello compulsive handwashers). We always seem to be reaching for the perfect 10.

With several conspicuously glaring omissions (infamous 'doctor' handwriting, lack of interconnectivity between admissions, care planning/delivery and follow up data, minimizing importance of patient-centric approach and involvement, etc.) healthcare is an industry obsessed with the pursuit of perfection.

Although we use terms like 'sick' and 'healthy' - what do these really mean? There's a reason our measures for recording and discussing a person's total health are highly subjective, while individual, isolated clinical results are related in quantitative terms.

Without numbers and lab values, we might actually come to feel we have little control over our health, and then where would the industry be?

We include both subjective and objective measures (SOAP notes) and observations on a record because both are absolutely vital in our conversations surrounding the pursuit of 'perfect' health - pursuit being the operative word.

But in sickness and in health, for richer and poorer, perfection is a pipe dream.

Unlike winning the lottery, it's statistically impossible, not just improbable, for any of us to be in 'perfect health.'

Patients never operate at a 'perfect 10' on the health scale. Even the best of us.

Doctors never operate (literally and figuratively) at a 'perfect 10' on the care delivery spectrum. Even the best of us.

Nurses never operate at a 'perfect 10 ' on following docs orders, administering meds, etc. Even the best of us.

You get the point. Perfection is healthcare's mission impossible.

And just like the blockbuster action flick series, we have our heroes, who pull impossible stunts in the name of improving the industry.

Granted, I follow these heroes with as much slightly occluded slavish devotion as friends who read Marvel comics, or rabid Apple or Converse All-Star devotees.

Don't get me wrong. We all need heroes. Many of us want to take a turn wearing the cape.

Do you want the good news or the bad news first? They're one in the same: American healthcare is Gotham City, so plenty of us will have a turn to play with superhero stuff.

We need people who reach for the impossible to show us lesser mortals how we can be involved in the dirty, underwhelming everyday work, the wire tapping, the surveillance, the analysis, the commentary and programming addressing what's going right, what's going wrong in American healthcare and how we might tweak programs, start companies. Heroes that shoot for 10s encourage us to shoot for 7.5s.

We're a paternalistic, patriotic, parochial bunch. And despite the pragmatism above, I remain glass half full on most healthcare reform efforts reaching for what's next.

So why the harping on perfection?


First, it's nearing election time, and we're seeing the monolith approach to policy evaluation for both candidates.

Monoliths work in dictatorships (until the populace revolts in attempted coups), monopolies, corporate sponsored white papers, and other flat, tired storylines.

Creative commons are slightly messy around the edges. Peer to peer networks defy the isolated superhero theorem. Service design means observing people interacting in the wild - and you can't tie up singular solutions with a neat uni-product bow. The Cloud is morphing all the time. Collaboration breeds singular productivity with a side order of randomness.

Reaching for a 10 results in a 7.5 and a bunch of flak. Some collateral damage, mistakes, tragedies are unavoidable, but that doesn't mean you completely stop trying.

I'm reading a lot about 'saving' healthcare. Doing some late summer introspection, I'll be the first to admit buying into and using such platitudes on occasion. Ok. On many, many occasions.

There are several reasons I'm increasingly concerned about American healthcare's pursuit of perfection.


1. It's impossible to achieve a perfect 10 in American healthcare. One big blowout routine won't save our system. We need a web of individualized, interconnected, tangled, messy micro-solutions which maximize targeted impacts.

2. The expectation that a mass-population policy approach like federally-funded universal healthcare will make everyone healthy (and many wealthy) doesn't pan out. There is no Neo waiting in the wings to free us from the tangled matrix of missed opportunity and mangled administration we've created. Or rather, we need to cultivate a multiplicity of internal Neos.

3. When we're after the pursuit of perfection, often we make terrible mistakes. Chew on this maxim personally. Now chew on it professionally. Tough to swallow both ways, no? Hubris and smirking self-satisfaction that arises from creating polarizing 'one size fits all' perfect 10 routines cultivates tragedy at least as often as it perpetuates creativity. Today is the anniversary of a 'perfect 10' solution the US used to put a halt to WWII - in 1945 we dropped an A-bomb on Hiroshima, killing at least 66k instantly and dramatically escalating the costs of future conflict ('soft' human capital and 'hard' capital).

So why am I still here? Why haven't many of us opted out? Why are second and third generation healthcare bloggers continuing to form groups with early pioneers and reach for the perfect 10?

There's hope. We keep trying to perfect the routines:


1. Why do we keep searching for what's next in healthcare, no matter where we live, no matter where we work, no matter how our system is organized?

2. Why are people fascinated with defining and redefining Health 2.0? We're having the largest ever Health 2.0 US event in October.

3. Why are global hives of people coalescing without pay, spending personal time and money to revise outdated systems approaches?

Many of us realize perfection is unobtainable, but improvement is absolutely unavoidable. What role do you want to play (insert your own comic book/action hero alter ego here)?

Despite snark, hold fast to belief in healthcare heroes. They often disappoint us. That's called being human. They occasionally amaze us. Ditto on being human.

Shoot for the impossible. Only then do we start to believe in the improbable goals. Perfect 10? Doesn't sound half bad. That's called having faith.

Now act on it. If you need somewhere to direct that drive, I know plenty of all star teams looking for semi-heroes. Sometimes a 7.5 may as well be gold.


1 comment:

Vijay Goel, M.D. said...

Not sure I agree with you here. We're not shooting for perfect 10s. We can't even define if our scoring system is 1-10 or A-F at this point. It might even be smiley faces to frowny faces (the pain scale).

We're trying to achieve best results in a sector where we don't track results, agree which ones are best, or even map out consistent processes.

I think the better analogy is that the health industry is filled with skilled craftsmen, each expected to create a flawless work while constantly adjusting to new tools, raw materials and external conditions. We're trying to achieve a manufacturing environment while depending on skilled artisans...this is why most of our scoring systems don't even make any sense.