It is great sport to watch the players on the medical pitch perform before their small audiences.
At the Mayo Clinic, I watched a premier league competition full of well trained mental athletes, populated by rigorous quality checklists and processes and perhaps most tellingly, their team was imbued with numerous demonstrations of very smart, very systemic understandings of the game. For example, they had every player respect the science of blood pressure measurement. They did not rely on a single reading. They captured a continuous series of 5 readings, knocked out the high and low readings, and took the average of the rest as their measure. Other teams and leagues that I have observed took a single reading and moved on.
The Mayo players were fully conscious of the inaccuracy of a single blood pressure reading and their game plan created a fail safe mechanism to ensure no one forgot that as they played the game of medicine. They scored a lot of points with me by having that in their playbook – which included many other similar insights from infection to prep to checklists.
I had two hours recently to observe team play in the urgent care league. I sat in a visually antiseptic room with septic coughing and sneezing sick people all around me. A child ran around touching everyone and everything, her father finding it impossible to interact with her without escalations and tears and threats.
The ticket taker, the first human contact in the game, insisted that everyone wait in line to see her. The ticket taker was positioned in the middle of the waiting room, right in front of the seats. Like confession, every person was first asked what the nature of their torment was. Unlike confession, their intimate answers were heard by all of us. Flu symptoms, infection, and pain were reported for all of us to hear – and we each made sure to catch a glance at the people sharing the more interesting confessions.
Otherwise, we went about our business of reading, staring down, working our phones, watching the small wall tv showing medical information or avoiding the energizer child. The ticket taker then took identification, credit card and health insurance information and asked each person to fill out a 4 page paper form and return it to her. Every 20 minutes like a cuckoo clock a person from the hidden recesses of the facility popped out and apologized for the wait to the often long line of fans, thanking them for their patience. The expected wait time was about 1.5 hours to watch the actual game – in the waiting room were just warm ups and practice and a lot of stretching. The actual game took place somewhere behind the ticket taker. It was first come, first served, first to get to watch the game. No triage, no reserved seats, no platinum elite access. The game itself never lasted more than 20 minutes or so. A tech or nurse, a waiting room, a wait, and then the game – a doctor began to play but sometimes a nurse or technician were the only players.
There was not much contact, not much drama, really not much of a game. But it was the only game in town beside the emergency room league playing every moment of every day at the regional hospital stadium. Only rubbing alcohol is allowed in the stands. Purell pumps instead of mustard pumps. People sick as dogs instead of hot dogs. Such a bummer.
“Bad bad bad medical system” we say, like we do when we catch our pet soiling the rug.
Saying bad bad bad does very little to change things. At Y Worlds, we would like to be a part of a change process, not a part of the million critical comments that never translate into change.
As we begin to roll out our Nurture, Equality, Truth and Systems model, here are a select summary of high level understandings that invoke a wide array of generative improvements to the thing, the human construct, we call a health system.
From the Y Worlds NETS Model:
NETS begins with Nurture
The privacy and dignity of the individual can be achieved by modifying the intake procedures at medical facilities. First and foremost is instant initial triage to determine what the situation is, what the person’s status is, and what can be done to provide that person with the best assistance, services and guidance. Addressing Equality, no human body is the same as another’s and no human being presents symptoms or handles intake rooms at institutions the same way. Nurture, Equality and Truth merge to insist that we interact with each person as a complex individual and the process we call triage is actually intended to provide an experience, even a relationship, that comes as close as a loving, knowledgeable parent or caregiver might provide. Cold care does not work as well as humane care.
It may actually be less costly and more effective for certain chronic or pervasive medical conditions to be addressed by a mutually agreed to systemic allocation of a new category of caregivers for a long term bonding relationship – live in, nearby, remote video.
Nothing created by Humans is a System in our Ontology unless it is systemically designed as a comprehensive system based upon NETS. There is no health system, no intelligently and compassionately designed health system, there are only manifold components thrown together as a patchwork – each mostly addressing one piece of the problems at a time. Lets reject SLANT – thinking that what we have is some sort of an effective well thought out system. It should be clear by now that what we have is far from it.
A NETS system would emphasize prevention, through intensive education throughout our lives as a primary directive, as the primary objective
We need to become much more knowledgeable and self sufficient about the workings of our own bodies. Our institutions of education need to make learning about our own bodies a priority — to the level of a professional nurse. We need to make learning about ourselves a priority.
Public schools, parents and health organizations should teach comprehensive systemic health and medical knowledge. They should develop processes for individuals to obtain relevant longitudinal reference information about their own bodies.
Waiting rooms and treatment rooms are infection and disease exchanges. Humane, gentle triage and isolation clean rooms for those with communicable symptoms serve to separate the communicable bio agents away from the high risk visitors.
The evidence is overwhelming that self measurement, self diagnosis and self treatment has and will continue to exponentially increase due to the SWAY of medical access and costs, and to the continued invention and evolution of a wide range of machines, instruments, chemical and bio agent diagnostics, and enabling technologies. Lets organize this potential using a proof based evidence model into affordable fail safe toolsets for all of us. And of course, certified and highly trained medical personnel with advanced diagnostics should be consulted whenever it makes sense or reduces risk factors.
With Truth, we need to recognize that there is much about diseases and illnesses and human bodies that we do not yet understand. Every opportunity for medical education, including self education, should include systemic understandings coupled with checklists of what we know and do not know. The checklist, for example, would identify the pallette of diagnostic measures for particular symptoms in order of procedure and importance, and would identify that any time a blood pressure reading is taken with current instruments, it should follow something on the order of the Mayo Clinic protocol… and more.
Systems & Freedoms
Well thought out Systems enable people to experience maximum freedom. People may choose to smoke or eat or drink themselves to death. NETS suggests that we, as a compassionate evidence based free society, can intervene at the earliest stages of a person’s life via education, modeling, access to support services and effective protections without damaging the principle of freedom.
Taxing at higher rates not only the consumption of such known depleters of human potential as smoking and alcohol but also the producers of such products allows the currency received to be invested in prevention and treatment. Added taxing should be calculated and tied directly to measures of the direct and indirect systemic costs of these products to the societal fabric. The regulatory burden of government across all known sources of harm to human beings needs to be shifted more to the actors responsible for the sources of known harm. Individuals and organizations should be expected to produce a simple Proof Process that shows they acknowledge their responsibility to see that known harms are prevented and have acted accordingly. If they lie or fail to act responsibly according to their own procedures, enforcing their mandate, they will be held accountable for their failure to act. Court and enforcement requirements should substantially decline as the penalties for the heads of organizations not to comply would be so severe they would most often institute strong controls to ensure their organization acted on NETS principles.
Rewards and consequences should be linked transparently and seamlessly to objectives. If it is health we are after, understanding the art and science of health needs to receive investments and rewards, avoiding or preventing damaging exchanges needs direct support and rewards. Enabling and empowering people to achieve their conscious, subconscious and corporal potential should become a mandate, and after living ones life, accepting the end game of life as something to be absorbed and shared, not fought with painful forced pyrrhic interventions.
Y Worlds. It is urgent that we care. It is more urgent that we care systemically.