the machine is broken

October 2, 2017 was the release of an article I wrote for KevinMD, The title "How the nurse makes it possible" implies nurses have the ability to get you, the patient and consumer of healthcare thru the systems safely and efficiently. Lately I feel this title is a bit misleading. Not because the nurse doesn't make it possible rather the nurse can't be the only one trying. Let me clarify!

Healthcare is a very complex machine that requires everyone involved to be on the same page and devotion in order to work out. When everyone is not on the same page, well breakdown happens. When you have some healthcare workers, such as nurses, trying their hardest to ensure care is delivered, others put their personal agendas first. Personal agenda and opinion can cloud and taint initiatives created to keep this machine running.

As a healthcare provider for 20+ years, I have struggled with people who enter healthcare and their true intentions. While some try so very hard to ensure fluidity, others block efficiency for personal gain or power. This concept has never made much sense to me, yet I see it frequently regardless of what nursing home, clinic, or hospital setting I have worked. I feel nursing can save healthcare and the nurse will make it all possible, realizing my views are becoming less hopeful. Yes the nurse is the one who gives the medications so you can get better, washes you when dirty, and does all that is needed to move you thru the "machine." Now I must rant why all of that is great, but it could be better!

The nurse moves you thru the system but at what cost? Was it the fastest it could have been? Did they drag their feet getting report or moving you to the next unit? Did the physician respond as fast as they could or did they roll their eyes at your page and answered it when they felt like it?  Did you the nurse do everything in your power to get attention for your patient or did you accept the "way things are?" 

This is not a political rant on healthcare. This is not a a notion to blame or a venue to share solutions. Rather an insight to why this country struggles so much with healthcare. The machine my friends is very rusty, old, and has some bad operators! The machine is broken!

Why is the Machine Broken?

Take a simple process like moving a patient from the emergency room to the medical floor. I have seen this process done in roughly 8 steps or less. If everyone involved in the process works together and without personal gain or biased opinion, efficiency can be awesome. I have also seen this process done in 20+ steps with disregard to the overall goal. Evidence and data can show a need for immediate change, yet stakeholders blatantly refuse to change or hear a solution. Because of who is "in charge" can mean the difference of improvements versus stagnant solutions based on personal anger and attitudes needed to improve situations. People in positions needed to make it possible for the nurse chose to put their personal views ahead of the overall mission.

I have witnessed this for years. Sad but true. Some times your poor experience is related to a piss poor person wearing a stethoscope or holding a fancy title. I often wonder is efficiency is viewed as a threat to those is power. Think about it, if the machine is fixed and works well, maybe the maintenance becomes less? Is this why those who can truly fix it don't?

Personal gain, job security, and lack of of passion leads to a compromised solution to a mess we currently see. The healthcare worker, in any regard, is overworked, over stressed, under supported, under appreciated, and underpaid. Those who truly want to fix it are disregarded and then tossed to the side when their passion and frustration boils over. 

I am not here to judge, blame, or point fingers. I am not here to say I can do better or listen to my ways. I am here to say we need to all get on the same damn page if we want to make healthcare better. Some days I think "can it get any worse?" and often think "oh dear god it can!" The simplest things to fix are often so hard. Why? Because not everyone is on the same page! Not everyone heard the latest rationale, while others practice to their own personal beliefs. I tell people all the time, "just make it about the patient and know that is supported." But is it really supported? 

Back to the "do they really want this fixed?" thought for a moment. Let me rant a bit more so I articulate what I mean here. Politicians often say they are going to do this and that in order to get elected. Once in office they easily settle into the positions, deal with the day to day, forgetting the basis of their platform. They want to fix things, however once knee deep and then waist deep in the ways of others, they quickly avoid certain issues. They figure they will go away on their own, someone else will hold the corrupt person railroading things accountable, or they will just stop caring. Why? Because it is easier than putting up the real fight. Maybe if they do fix it they will be viewed as obsolete and not stand a chance for re-election. 

I could not help adding a political view to share my rationale to why the machine is broken, I just couldn't help myself. Often times the real issues are simply not dealt with, rather we find ways to work around them. We shave off some of the dismay, avoiding the real problem. Why is this? Because we are afraid to deal with the true problem here. It is so easy to talk about the necessary changes and create a blanket statement of responsibility while permitting the continued garbage that breaks the machine in the first place. Yes my friends we allow garbage to infiltrate the machine all the time and we turn our heads to it. Why you ask? Well it's simple, because when we do complain about the garbage we are seen as negative and as the problem.

So who wants to fix it and doesn't care what the repercussions may be? Who is ready to challenge the status quo and ask people who supposively care to change their ways or get out? I mean seriously here. IF you say one thing and do another then you are considered to be hypocritical. It may or may not be your fault, could have been how you are raised, or you just lack the ability to see past the nose on your face, regardless you may not belong in healthcare. Unfortunately too many people like this do belong in healthcare, You see people are smart and told to be doctors or they just want to make money, while others have a deep down internal desire to help people. Mix all these personalities up in a blender with political jargon and pour it out on a blank canvass. What a picture!

I wish we could "close" for a month, regroup, weed out all the crap, and open our doors with a fresh start. This would allow you to deal with situations without any new ones getting in the way. Its very difficult to fix things while dealing with new events and events your not aware of. The machine is broken do to so many variables its hard to comprehend and get them down on paper. If it was that easy, then we wouldn't be in this situation. There is so much I don't even understand in terms of payer mix, insurance, charges, behaviors, personalities, systems, and solutions.

We all need to work to survive and we all deal with stuff on a daily basis. I preach to leave that stuff at the door and do the best you can while on the job. Make it about the patient and put them first. Sure! Sounds so easy. Just make it about the patient. But what exactly does that even mean anymore?

People now consume healthcare resources for more reasons than we are even aware of. People use and abuse the system while others just avoid it. Some pay and some don't. Some have insurance and never use it while others don't have insurance and use more resources than you and I put together. The solution is so easy and very hard at the same time. People do what they want and feel they are entitled. The nurse may tell you what is needed to hear, yet the person hates them because the truth hurts. Doctors and nurses are judged on a daily basis where personal opinion blocks what is right. This leads to biased views and hurtful comments followed by a disregard to doing the right thing. The cycle continues, healthcare workers get sick and tired of it and just start to show up. They go with the flow and are afraid to say anything if it disagrees with those in power or lying in the bed. 

While it is important to vent this frustration it is equally important to strive to fix it. The desire to make it better outweighs the variation and discontent seen on a daily basis. 

I often say I will go to my grave trying to fix healthcare. Hopefully "enough of us" still exist nationwide to fix this machine. For the most part, nurses want to, doctors want to, but I'm not to sure of those in need of a job and those in extreme power. So if your one of my readers I must ask you one simple question.....

When your lying in the bed who do you hope is in charge of your care and making it possible for you to get better?

We all deserve healthcare, therefor we all BETTER respect it!