In Hollywood, the acronym "POV" is universally understood to mean "point of view," and when characters speak through the medium of a script, the "POV" of not only the character, but the scene itself, has to be clearly understood - lest the message or the effect of the scene be confused and essentially squandered.
The concept of POV can be more than useful to us in healthcare. In fact, when we're responding to the joint emergencies of patient safety and evidence-based best practices, we have a huge problem with the concept of POV: Precisely whose point-of-view are we discussing on any given issue?
When it's physicians grappling with accommodating best practices versus maintaining extreme physician autonomy, the POV involved is obviously that of the physician's best interests. (Of course, healthcare has traditionally signed off on the idea that the doctor's best interests and the patient's best interests are identical).
When it's a hospital or major health system's management searching for the balance point between the extremes of ignoring emerging best practice knowledge (at great legal risk) and risking a war with the medical staff by imposing what the "C" suite determines to be best practices, the POV is clearly through the eyes of governance, economics, and managerial prowess.
And when it's the beleaguered nursing staff facing the Hobson's choice of truly caring for their patients versus doing more with less and less, the POV is clearly one of professional frustration and helplessness, leading to burnout and disconnection.
"What we have here," said the wonderful Southern actor Strother Martin in the movie Cool Hand Luke (after backhanding Paul Neuman's Luke into the ditch with a shotgun) "...is a failure to communicate!" I've been hammering away for nearly two decades to medical audiences about the inescapable role of miscommunication in every aspect of patient safety and service quality. But the reality is that the type of miscommunication that has done the most damage in holding back a unified view of what is needed in each and every medical facility is essentially a modern version of the Buddhist parable of the blind men and the elephant.
If you'll recall, each blind man was feeling a different part of the elephant and while accurately relating his own experience and interpretation, was mis-communicating the reality of the pachyderm's overall nature to his fellows - who were simultaneously turning in the same dysfunctional performance. Five or six blind men equaled five or six entirely different Points-of-View, and correspondingly, no possible consensus on the nature of the beast.
We not only need a common and unified POV to effectively handle the problems we're facing in American healthcare, we need that consensus immediately. In fact, the myriad individual POV's of what ails healthcare are perpetuating the very dysfunctionalities we're trying to cure!
If, for instance, we get so bogged down in dealing with the necessary but very parochial POV of finance and solvency that all other POV's are eclipsed, the true emergency need to take healthcare from high-risk and low-reliability to the opposite ends of both scales will continue to be held hostage. In that case, the demands for cost-accountability will continue to reign supreme, and we'll end up eventually as embarrassed as the Federal Aviation Administration was a few decades back when the public learned that their FAA had assigned a dollar cost to a human life in order to know when it was cheaper to accept more passenger deaths than require new safety measures. Stop and ask yourself, just how far are we in healthcare from that same point?
Of course, this is not to flail at the C suite in any way, since there is a clear axiom: Ignore the dollars and the doors close. But aligning the POV's of finance, service quality, patient safety, and practice autonomy with the ultimate POV - that of the patient's best welfare - has clearly become an overriding and immediate Prime Directive (yes, I know, another Star Trek reference).
Here's the main point I want to get across: Finding a common POV is as easy and effective as making a common pact that first, last, and always the patient's best interests override virtually every other consideration. With that one agreement we can restore sight to the blind and align our focus in the same moment.
If, for instance, it's the patient's POV that governs, why would anyone advocate for less than a full and robust program in each medical facility to discover and immediately implement the best practices? If we have the patient's POV, why would anyone refuse the nurses a voice in how many hours of care are really needed, undermining their efforts to spend time with their patients and administer the human and humane care that only nurses can provide? If it's the patient's POV that drives us, imagine what else we could accomplish? Maybe even designing a system in which healthcare professionals and institutions are compensated in direct inverse proportion to the decreasing need for their services.
The entire ethos of the St.Michael's Hospital model in Why Hospitals Should Fly is based on the patient's POV, and in my view, it's high time we started openly discussing this as one of the first changes needed in any institution.
