I’m spending time at a local hospital with a loved one for something that was ex ante scary but ex post became boring after nothing turned up in the usual tests.
A few things stand out from this experience: The impressively harmonious rainbow coalition that makes up the American health care workforce, the strange mix of technical virtuosity and incredible organizational inefficiency in hospital care, and just how different the patient experience is outside the environment of safety-net and urban teaching hospitals many of us know best….
(This post is cross-posted on the Century Foundation’s Taking Note section here.)
The impressively harmonious rainbow coalition that makes up the American health care workforce.
Our Catholic hospital played a sweet blessing over the loudspeaker while a headscarfed Arab-American nurse took vital signs before passing the case off to an Irish Catholic young woman with an impressive number of ear piercings. People of many racial, religious, and ethnic backgrounds wandered through the hospital room doing whatever it was that they needed to do.
Obviously the demographic composition of the cardiology fellows looks different from the nurses and the food staff. Still, I don’t know if I could identify an economic sector that reflects America as well, or that works as well in its diversity to get important things done. These busy and diverse people also treated us with a mixture of competence and kindness that is really quite admirable, and which should never be taken for granted.
The strange mix of technical virtuosity and incredible organizational inefficiency.
The virtuosity is palpable, even or especially in a community hospital not especially known for being high-tech. Much of the high-tech equipment is effectively operated by people with limited technical training. We tend to think that advanced devices increase the demand for highly skilled workers who can operate the technology. A lot of medical technology is intellectually labor- saving, making complex tasks simpler, and thus ready to be performed well by people with less advanced or less specialized training than you might suppose.
The inefficiencies are equally palpable. We arrived 6:30am yesterday and spent much of the day twiddling our thumbs waiting for an echocardiogram that was finally done 11am this morning. The attending was unavailable to sign a requisition form. There was a shift change. There was delay/someone forgot to do something. And so on. Many inefficiencies and mistakes occur because the managerial, organizational, and human-factor technologies lag so far behind behind the more material ones embedded in the fancy machines.
How different the patient experience is outside the environment of safety-net and urban teaching hospitals many of us know best.
This particular hospital is a good but hardly-prestigious suburban hospital somewhat insulated from the safety-net function of some peers. The ED wasn’t overcrowded or noisy or filled with uninsured people with complicated social-medical-poverty concerns. We had essentially no wait. The rooms were pretty nice. Parking was free and convenient. I wouldn’t want brain surgery there. Yet most of the time, one’s personal experience of care has little to do with the technical proficiency with which that care is provided.
Finally, the experience brought home the competitive dilemma facing many urban safety-net and teaching hospitals. They often provide excellent care. Yet they can be pretty uninviting places, too–in part because they bear economic and social burdens that other hospitals do not.