Welcome to the kickoff of my "Flying Hospitals" Blog! The philosophy is simple, but needs to be stated up front:
WHY HOSPITALS SHOULD FLY presents a model of what a safe, well-run medical facility would look like and feel like if all the great ideas being discussed out there were incorporated into one facility. But this "ideal" is anything but a static target. Instead, St. Michael's (and any good institution that seeks the same level of excellence) is a moving model - a work in progress - and that's where this Website and this Blog come in.
What I hope to provide over the next few years is a growing body of discussion about how to effect such seismic cultural changes as are presented in the book, as well as provide a growing resource of citations to those institutions that are already incorporating the principles of St. Michael's into their culture. In addition, I want this site to host a healthy running discussion of how to improve the model, change it, and add to it, whether in terms of various components (nursing, administration, ICU setup, etc.), or in terms of overall philosophy, and I know that this information can only come from you who labor daily on the front lines.
Hearing from you that something Jack (in the book) claimed as a new idea is, in fact, actually up and running in your hospital is precisely what I want, especially if we can send others to your doorstep with questions on how to be equally effective. New papers, studies, and theories are welcome as well, but the most valuable contribution of all from those of you who take the time to communicate is what aspects of the St. Michael's Model are already working - especially "radical" ideas such as turning staffing control over to nursing and reorganizing the physical layout of a hospital floor.
Remember, though, that the underlying strength of the St. Michael's Model (or that of ANY good medical delivery model) is the human relationship matrix that prevails there. A staff that has yet to learn and embrace the invaluable principles of collegiality, or one that can't focus on and openly discuss the common goal of helping the patient while incorporating deep, mutual respect for each other, can never reach minimally acceptable patient safety or service quality levels. And yes, that's both a pejorative and a proffered axiom, but it is absolutely vital. Hospitals are, after all, human institutions, and the majority of the problems leading to patient safety disasters, staff dissatisfaction, and quality crashes are directly traceable to dysfunctional human interactions in these principal areas: Communication, Perception, Assumption, and Mutual Respect.
Remember, too, that there are at least 7 massive areas of dysfunctionality in American healthcare, and it's vital we clearly understand those different categories if we're to effectively solve the prodigious problems inherent in each. By my estimation, they are:
1. External Insurance (the 'universal coverage' debate that most Americans erroneously think is the only healthcare challenge);
2. The ongoing Internal Insurance crisis for practitioners and medical institutions;
3. Physicians in crisis, especially in terms of the daunting challenges to a happy practice and the degree to which our medical schools must change their training (and are loath to do so);
4. The near-meltdown of the Nursing Profession and the urgent need to recognize how perhaps the most vital lynchpin in the hospital-patient safety equation is teetering on the brink;
5. The Medical-Legal disaster, in which I can tell you as an attorney with special expertise in this area that the Tort system will never be able to serve the interests of the American taxpayer and absolutely must be disconnected from what is in fact medical MIS-practice in probably 90% of the cases;
6. Patient Safety, and the ongoing challenge of changing a high-risk human endeavor to a low-risk, high-reliability operation;
7. The overall philosophy of American healthcare, and the need for us as a people to debate and decide whether it is, legitimately, an "industry," or something else entirely.
So, again, welcome to the kickoff of what I trust will be a lively and growing forum of dedicated professionals equally concerned with overhauling "The Way We've Always Done It!"
John J. Nance
Seattle, May 21, 2008
