Tuesday, August 24, 2010

The 10 Most Powerful People In Health Care

In case you haven't seen it, the media's list of the 100 Most Powerful People in Health Care was published yesterday. In thinking about this list I realized that in reality, these people had little to do with my patients' health care delivery. So how did they became the most powerful people in health care? Quite simply, they are not the 100 most powerful people in health care, but rather they are the 100 most powerful people overseeing the funding of health care - at least for the moment. In as little as 11 months, many of the people on this list will be gone or have moved on to their next money-making venture.

So who are the most powerful people in health care?

Well, I'd like to propose my list - maybe not of a 100 people (frankly, nothing gets done if you have a committee of 100 people anyway) - but rather my own list of the Top 10 Most Powerful People in Your Health Care today:
10. The Doctor - They consider the differential, write the orders, follow-up on tests, and move the health care ball forward throughout your hospitalization or stay with a rehab facility. As such, they should be given their power due, even if many other members of the health care team are actually are the ones that make sure the care happens. Still, because the doctor gets most of the liability risk if things don't happen or happen incorrectly, they just make my power list.

9. The Food Service Personnel - These folks are powerful. They have the ability to make even a clear liquid diet look like real food - especially when they mix the colors and flavors of jello. Further, proper parenteral nutrition for an ICD patient greatly shortens the sickest patient's hospitalization. Get it right and everyone benefits. Power personified.

8. The Physical Therapist - If you can't eat your food, sit up, keep your muscles toned, maintain the range of motion of your limbs when sick, the chances of returning to independent living are limited. Physical therapist have come of the most helpful techniques to get going - both physically and mentally - like turkey bowling. Their power over our patients should definitely be appreciated more.

7. The Social Worker - Want to negotiate the complex Medicare and Medicaid rules for placement in an assisted living facility? Need to get a patient to rehab? Want to arrange transportation for a patient that doesn't have a penny to their name? Make something from absolutely nothing? Call the Social Worker - but call them early in the hospital stay. (They're never at their best with last-minute consults.)

6. The Nursing Supervisor - Trust me on this. No one has more power to assure adequate staffing on each patient care ward each day than the Nursing Supervisor. Medical students and residents that cross the directives issued by this individual do so at their own peril.

5. The Bed Coordinator - If you need to admit a patient to a hospital, they must first get a bed. With many hospitals working at or near capacity, no single person has more influence over the patients admitted to a hospital facility. They find beds when no one else can. After all, it's their job.

4. The Hospital Operator - Name one person who can activate a Code Blue (cardiac arrest), find the obscure specialist in the middle of the night when they're most needed, or mobilize a trauma team faster. Can't do it? That, my friends, is power.

3. The Night Shift Nurse - At three in the morning when you're lying there in the hospital bed and need something - anything - who's the most important person in the hospital who will assure you're needs are tended to? Need I say more? If the night shift nurse is inattentive, unresponsive, irresponsible for that 8-hour shift - you're screwed. On the other hand, if she's attentive, knows when to call for help, or provides pain relief when you need it most after surgery, or - most important - gives you that laxative at 3AM - his or her power in medicine pales in comparison to any bureaucrat, politician, or hospital system CEO.

2. The Patient's Family - Often forgotten, family members have huge influence over the care provided to their loved one - especially at times where their loved one might not be able to communicate. This power should not be ignored, but it cuts both ways, too. While family members can facilitate the treatment and rehabilitation of their loved one because they know them better than anyone else, they can also prolong undue suffering if they do not comprehend the limits of care that their loved one desires in the end-of-life setting. Families that communicate their needs and wishes before anyone gets sick avoid much of the confusion during this difficult time and serve as powerful allies to the health care team.

1. You, The Patient - No one has more influence and power over their care than you. Don't want care? Leave. No one can stop you. Want care and don't have a penny? Come to the Emergency Room. You won't be turned away. Wonder what all the big buildings, waterfalls, and fancy technology were built and bought for? You. Every single person involved in health care is there because of you. So make the most of it. Come prepared. Know your medical history, medicines and allergies. If you can't remember, keep a list with you. Ask questions. Insist on clear answers. Work with your care givers, don't fight them. If you're not sure, get a second opinion. Write a letter acknowledging those that made the extra effort and scolding those that didn't. Your constructive criticism makes the system better. And know that hospitals understand the importance of your word-of-mouth referral - it's the most powerful marketing strategy a health care system can generate. Finally, remember that you can vote for politicians that don't forget who's in charge. You are the ultimate power broker in health care. Don't forget it.


Chris said...

Dr. Wes,

I like your poke at Modern Healthcare's top 100 most powerful people.

Your revised list really does get at the heart of care delivery and makes sense to me until it arrives to the family and the patient. I understand where you are coming from in terms of them ultimately holding the power on receiving care vs. not or choosing one facility vs. another.

But as a whole I would say that patients more often than not are consuming health care out of ignorance and in a state of fear. While they certainly can ask questions and challenge care routes, I'm sure they ultimately will defer to what clinicians recommend because they're the "experts" and patients are not sure what is right and what is wrong.

With health care being so complex patients likely don't even know what the difference is between a CT and MRI. So how can they say with any confidence that they do or do not want one?

Perhaps on the most front end of care delivery, the patient does hold all of the cards and controls who gets their business. But once they are caught up in the whirlwind of care delivery, I would point towards them having feelings of helplessness and uncertainty.

I believe that as providers focus more on patient centered care that we will move closer to patients becoming the top of the power pyramid; but I believe in the meanwhile we have quite a ways to go.

Chris LeBeau

#1 Dinosaur said...

Well said!

Heather O said...

Great post!
In response to Chris's comment, I see where you are coming from, but would add that yes, patients and families often don't 'have a clue' when it comes to much of what goes on in terms healthcare, but they do know how they are treated.
They may not understand the difference between an MRI and a CT, but they know when they are insulted, or when they are left hanging without answers, etc. They know who makes them feel like they matter and who doesn't. That absolutely plays a part in who they choose next time, and who they tell about the experience.
Not to mention, how they feel does have an effect on their progress, recovery, etc.
After spending 6months with my grandmother in 4 hospitals, I can honestly say that the others play a big part in the stress level!

Anonymous said...

Bravo Dr. Wes!

@Chris - I think the very best thing a doctor can teach his patient is one question - ask, how will this/that change management?

With a patient equipped to ask that question, a doctor can then communicate the benefit/risk of any proposed test - lab or machine - to the patient so they understand why a particular test is being ordered without having to understand the minutae of the differences in tests.....and if doc can't justify a result leading to a different management of any particular condition, patient then knows it may not be worth doing said test.