February 7, 2016

The Greatest Constraint Hospital Leaders Overlook

The Greatest Constraint Hospital Leaders Overlook

Hospitals that fail to deliver proactive care are failing as hospitals. If you’re not certain you have proactive care throughout your hospital, you probably don’t. And that’s costly, in both human and financial terms.

1Unit Proactive vs Reactive Care

Actual Hospital Care

Hopefully we can all agree that proactive hospital care should be routine. The logic is overwhelming. Prevent complications before they happen. Recognize and respond to deteriorating patients as early as possible. Detect delays as they happen and act to minimize the impact. Stay ahead, course correct, and advance progress every day. Makes perfect sense. So much sense, in fact, it’s understandably what patients expect us to do every day.

If only they knew the truth.

Even in the most modern hospitals, proactive care on medical units is exceedingly rare. If you doubt that, I urge you to search for descriptions of proactive care, in which interdisciplinary hospital teams routinely coordinate to stay ahead of issues. Considering the magnitude of the problem, examples are not easy to find, especially outside the geriatric literature. So here’s one we published in the Harvard Business Review’s health blog: A Remedy for Fragmented Hospital Care.

Better yet, try looking for proactive care in your own hospital. Trust me, this will be worth your time. Block out a morning on your calendar, go to a medical unit, and watch what happens. Rather than proactive care, what you’ll witness is most likely the polar opposite. Why?

Reactive Care

Because reactive care –  care that’s too little, too late – is the norm. Until hospital leaders address reactive care, it will remain the greatest constraint hospitals face and the price will continue to be massive and unnecessary. Details will continue to be missed. Windows of opportunity will continue to shut. Complications will multiply and patients suffer. Days and resources will continue to be wasted.

During your morning observing your medical unit, try to be an active listener. Be an interviewer and a note-taker.

  • How many different physicians are the attending of record for patients on the unit?
  • How many bedside nurses confess they are unsure about the care plan, or even the diagnosis? How many of these nurses waste valuable time searching the chart for answers, or paging physicians hoping for clarity?
  • How many patients express frustration about communication from their care team or about uncertainty relating to their care or discharge plan?
  • How many times did the physician, bedside nurse, and patient meet face-to-face at the bedside to update each other on status and make timely adjustments to a shared plan of care?

What you will be witnessing is reactive care. It’s everywhere, in plain sight, all day long. As a hospital leader, it should keep you awake at night.

If there’s a positive spin here, it’s this: there are tremendous operational gains just waiting to be captured by switching to proactive care. But how? And what does proactive care look like?

Proactive Care

The first time you see proactive care it’s unforgettable. In one sense it may look like nothing you’ve ever seen in a hospital.

In another sense, proactive care looks exactly like what we should be doing for patients every day. With proactive care you see the doctor, nurse, and patient all together at the bedside exchanging perspectives, cross-checking vital information, making adjustments to a shared plan, and identifying actions that drive progress and recovery.

Fortunately, the key personnel for proactive care – the patient, bedside nurse, and primary attending physician – are available in the hospital every day. The transition to proactive care does require an investment in logistics, change management, and skills building, but many hospitals are recognizing the imperative to make that investment.

Proactive Care Fundamentals 

Fundamentally, proactive care is team-based, patient-centered, and routine. It uses foresight and collaboration to actively advance progress, reduce risk, and prevent costly complications and delays.

What drives proactive care is Structured Interdisciplinary Bedside Rounds in units where physicians and nurses share time, space, routines, and advanced communication practices.

For hospitals to deliver efficient care consistently, each hospital unit must run like an engine of proactive care. Hospital leaders have the unique power and responsibility to ensure that happens.