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As the Phillies go, so goes Health Care: Lessons on how to fix our Broken System

We have learned a lot in this last year through our thorough investigation of the caregiving crisis and its deep roots in our broken health system. In fact we have learned even more about the intractability of our health and social institutions in advancing real change.

We have also learned a lot from observing the steep slide of the baseball teams with the biggest payrolls, with our personal laments focusing on the Phillies, Mets and Yankees. You might have your own preference.

What is it that makes us love to see the fresh faces of players who have been carefully trained in the fundamentals of the sport, rise to the top of the baseball hierarchy? What made the Diamondbacks shine in their contest with the Phillies sluggers, and surpass most everyone’s expectations in their defeat of their glorious, but inconsistent rival?

We will return to that in a little while.

The New Aging Partnership has been dedicating our time to unraveling the issues with the caregiving crisis. We have gone through many twists and turns, all leading to our current assessment of what is revealing itself to be the “fault in our destiny.”

We in the US have been traveling down a slippery slope in our efforts to manage health care, and everything else associated with it, through the application of business and market principles. As a nation, we have been searching for the Holy Grail, as represented by the Big Business curatives for a failing health system for so long, that we can no longer recognize that healing has very little to do with algorithms and technological advance, and much to do with the principles outlined in the Hippocratic Oath.

Rather than go into the details, suffice it to say that the oath is the earliest expression of medical ethics in the Western world, having established certain standards that remain of utmost significance. Nurses pledge to uphold the Hippocratic Oath, do no harm, practice discretion and be dedicated to their work as nurses. I think it’s safe to say that each profession has an oath, my own, to pledge to consecrate my life to the service of humanity.

Considered together we are led to an awakening to the essential problem with our health and care provision in this country.

Health care, sadly, is not constructed on the ethical principles that guide professionals, but by economic priorities. The literature is replete with evidence demonstrating the current focus on cost-efficiency, technological solutions to filling gaps and reducing redundancies - none of which seem to be reducing fragmentation and duplication, or providing universal access, for that matter.

Examples prevail, including stories about different home care providers giving multiple baths to patients, as an example of duplication based on lack of communication. The expansion of the much vaunted hospital- at-home movement is compounding the confusion regarding which organizations are responsible for what service in cases in which a patient is dually enrolled.

Needless to say, the fragmentation and duplication in the rapidly accelerating home service delivery sector exists on an inter-professional level, as well as an organizational level.

Academic institutions and medical centers are growing in appreciation of the need for education for more effective collaboration, but much of the education takes place in professional silos and is not focused on home service delivery.

The Philadelphia Phillies

Having observed this team and other high profile, loss leaders in baseball, and reading the commentary, it seems pretty clear that if these teams ever overcome their challenges, they will need to get back to the fundamentals of baseball. I can hear Charlie Manuel chanting “Small ball.”

That’s all they need to do. The Phillies played well when they weren’t shooting for the stars, leading to the impression that when the pressure rises, the big bats revert to what is instinctive for them; and that is, “swinging for the upper decks.”

An analogy can be drawn between Big Health and Big Baseball.

Health care needs to get back to its foundations and do the following:

  1. Teach the students well, and how to work with other disciplines in order to promote better patient outcomes;

  2. Promote primary care;

  3. Restore professional autonomy and the mission to serve over the mission to profit;

  4. Promote public health.

Those are just the basics. But, how do we get there? That is the rub!

New Aging Partnership has refined our objectives to focus on promoting inter-professional behavior, with a particular focus on home service delivery. Why?

Because you can only be as honest as the system will allow; and, despite concerns about over-reliance on home care, home service delivery is growing exponentially. We need to prepare students from varied health professions to “hit the ground running.” Seasoned professionals also need to be re-oriented to new functions, and that includes health care leadership, who need to focus more on aligning services and roles within their institutions and within their communities.

The fault in our destiny is not that we are fated to a specific destiny; it is that we are not making the right effort to influence our destiny.

New Aging Partnership started out our journey focused on the caregiving crisis, and that remains at the root of what drives us.

Because the way we are heading is only going to result in more and more responsibility falling on families to fill all of those gaps that would be more effectively filled by the professionals who are so much better suited to the task.

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