White Platform: What If

WHITE PLATFORM : "WHAT IF...” AND I NEED EXPERTISE

Medicare, Managed Care, Clinton Care, Obamacare, Hospital Care, Home Care ­ many terms have been applied to care and caring. Our "system" of care has many references in myriad articles and journals. Health and wellness, it is my contention, is a COMMONS, like fresh air and clean water. There is much to celebrate in the healthcare space and many "miracles "to memorialize. But there should be no argument that at the community level and, at best, regional micro ­ and sub ­ system levels there is presently NO true, integrated, interconnected, all encompassing ecosystem of health and wellness ­ anywhere in the world to model as an exemplar ­ YET. Hospitals and clinic ­ hospital integrated microsystems provide sickness evaluation and amelioration, symptom abatement, death delay and dying prolongation, homeostatic rebalancing, and repair and rejuvenation of pathophysiologic aberrancies, anomaly diagnostics with increasing detail sophistication and COST for an aging population in many geographic locales. Antibiotics and chemotherapies augment, enhance, and often cure ailments, allay pain, mollify and mitigate damage. The space has yet to experience the full benefit and panoply of genomics, proteomics, metabolomics, and microbiomic manipulations. Robotics, 3 ­ D printing, and synthetic biology and regenerative medicine will continue the incremental, evolutionary, scientific methodological progress in all fields, sub ­ domains, and siloed disciplines.

Yet the presses roil and articles abound with barriers written by naysayers and skeptics. The cost curve is unsustainable. Medicaid will sink state budgets. Medicare will be bankrupt by 2020. Massive doctor and nurse shortages are projected and trajectories mapped. An end to Social Security is predicted. There are crises of quality and access, and chasms and gaps filled with errors and valueless redundancies. EHR s and health apps (h ­ apps) will fuel quantified self improvements and be integrating panaceas. Precision, personalized, individuated medicine will inaugurate novel approaches BUT who will cover and reimburse for them, how will we pay for the requisite R and D and comparative effectiveness research, RCT s, and proofs ­of­ concept technologic advancements. The march of progress must be limited and rationed to effect the greatest mediocre good for the most many; cost containment and shifting, zero ­ sum games must be instituted to "bend the cost curve". Messes, crises, fuzziness, and chaos lurk everywhere as the gargantuan behemoth which is the healthscare space remains untamed and out of anyone ‘s control and bounds. Resource utilization, strategic planning, and customer ­ driven or disruptive ­innovation driven methodologies will save the turbulence and perturbations.
AND SO IT GOES ...

The WORLD FUTURE SOCIETY 2014 Orlando, Florida annual convention theme was: "WHAT IF...” As part of that convocation the enclosed outline was offered:

WHAT IF... What if every patient occupying an inpatient hospital bed were looked at as a FAILURE OF:

Care
Cure
Control
Health maintenance
Prevention
Pre emptive intervention
Diagnostic precision
Prognostication/prediction
Oversight
Education
Sensing
Help
Integration
Intercommunication
Timely trending
Monitoring
Accountability
Responsibility
Healing
Dys ease amelioration
Homeostasis
Balance

 

This skeleton (I am an Orthopaedic Surgeon after all) suggested a framework, are ­ visioning. Are we asking the "right questions "in the healthcare space, or, for that matter, in any areas of human endeavor and experience undergoing tsunamic change and massive information availability? When faced with turbulence, disruption, uncertainty, unpredictability, and ambiguity the RIGHT QUESTIONS are hierophanous and ennobling. And liberating. What bright minds could now be re ­ directed and re ­ purposed to embark upon the probing of these bold, new, insightful divergences from the present course and "inevitabilities"?

Also, WHAT IF...there were $5.64 TRILLION to dedicate to this re framing? (Enclosure ­and there are).

Could a straightforward question co ­ create a paradigm launch leading pro ­ active designers to catapult exponential organizations and microsystems toward platforms allowing even more emergence and progress? (I strongly suggest and believe we humans are that smart AND resourceful.) What cross disciplinary and combinatorial multiple pedagogies could be re purposed in the co ­ design and co ­ creation of NEXT + exemplars of excellence and achievement?

THINK (the WHATs):

  • SOCIAL JUSTICE / SOCIAL PROGRAMS
  • EDUCATION / TRAINING / SCHOOLING
  • POLITICAL
  • ECONOMIC / FISCAL / BANKING / INVESTING
  • GOVERNANCE
  • ORGANIZATIONAL / INSTITUTIONAL RESTRUCTURING

The WHEN (now ­ on our watch), the WHERE (nowhere­­­­­­­­­> NOW HERE), the WHO (us), the WHY (sense of urgency, current models are not ecosystemic ­ many things are broken, dislocated, disjointed, fragmented, dys ­ functional), the HOW
(multidisciplinary, combinatorics, best wisdom of best teams) Where could this begin and how to start?

The Healthcare Space and Today, for example:
THEN WHAT IF...

As providers of care make the current rituals of daily rounds (hospital rounds, team rounds, grand rounds, rounds and huddles, walk ­ a ­rounds) and consider ALL visits and encounters in every "hospital" (think: house call, office, clinic, walk­in, and hospital) ­ STOP and review the FAILURE list above. ­

And instead of considering admission and readmission rates, patient satisfaction scorings, computer data entry and busywork, providers AND patients (caror AND caree) consider together ecosystemic ways to prevent the ADMISSION in the first place, eliminating sudden needs, many acute events requiring ambulance rides to ED s, and general crises managements.

What would this look like from an economic / planning / insurance / political perspective and how would this model and graph and compute (THIS IS WHERE I NEED THE HELP!!!)? What could the future look like and how would the trajectories be DRAMATICALLY different in the model as to ­

  • Bed availability
  • Resource management
  • Utilization
  • Projected future needs
  • Doctor / Nurse / Extender "shortages"
  • Cost and expenditure trending
  • Hospital bottom lines and trending
  • Planning and strategy
  • Resource deployment globally
  • Education / training / CE for next carors
  • Global health, wellness, well ­ being, and productivity

Finally, recall this is only a PLATFORM feel free to build on it from here.

Thank you for attention and any constructive critique!

Frank W Maletz MD FACS
Orthopaedic Surgeon
Futurist

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