Friction in Healthcare

 

Collage of elements of Friction in Healthcare Doctor time poor looking at his watch, affects poor communication between doctor and patient, two clinicians talking to each other, no communication between providers caused by firewalls, Privacy legislation, organisational culture, personalities, time poor clinicians, increasing complexity of care often needing the see multiple specialists who prescribe treatments that conflict with other medications, no one is coordinating as the GP is time poor and huge numbers of patients, red tape paperwork and KPI's take clinicians off the floor and doing reports that justify their roles and mitigate risks of litigation and tick boxes lack of trust

In Australia, the health system is a massive industry.  Despite the government spending a lot of money ($185 Billion dollars 2017-18) this behemoth machine we try so hard to make work still falls short, mainly because it has been growing organically for decades. There are so many cogs – and with lots of moving parts, there is a lot of Friction and not enough oil.  (Nurse Nav is the oil.)

Do any of these sound familiar with your encounters within Health? (*Provider means Doctor/Nurse)

  • Communication is hurried, you are interrupted, your needs not identified
  • The provider is “on the clock” and you can see they have lots of other people to see
  • You don’t understand what the provider is saying as no one has time to explain so you agree because the doctor should be the expert right?
  • No one has discussed other options
  • You don’t feel anyone has time
  • You don’t think anyone actually has the whole picture
  • You have to see multiple specialists whose treatments conflict with each other or give you side effects
  • You wish you had someone to go into bat for you
  • You need help making changes, not an expert telling you what you already know

 Below are the main points Nurse Nav service is aimed to address. 

Communication between the patient and the provider

  • This is often hurried as the time poor clinician has to quickly diagnose and treat based on their experience and skills
  • Patients can’t speak the language and normally consent to things they don’t understand
  • Patients believe the clinician is the expert

 Communication between treating clinicians

  • Supports continuation of care
  • Due to no shared medical record, IT firewalls and Privacy Legislation, assessments, diagnostics, results, treatment plans and follow up care information is delayed, or not shared making everyone’s job harder.
  • Leading to failures of care and treatment, waste, confusion and patient harm.
  • Vital Clinical handovers between teams both within organisations and external are impacted by workplace cultures, personalities, and time poor clinicians.

 The delivery of “care” is becoming increasingly fragmented  

  • Clinicians become more specialised –providing care for one symptom often causing others to worsen
  • Communication issues impact other clinicians’ ability to support and follow on  

Increasing complexity

  • Humans are not cars – we have holistic needs – there is no one magic bullet. There is not one “shop” either
  • Clinicians are increasingly specialised – which means you have to see multiple people to have work done
  • Diagnostic testing and over testing is occurring
  • Treatment options are widely varied and often not discussed
  • The systems are becoming more complex. There are many different teams and specialties within a hospital, that half the staff don’t know existed
  • Better treatments and higher standards of living contribute to us living longer – yet we are sicker, with more conditions and more complex to care for.

Coordination

Who is project managing you? Responsibility is shared usually with your GP who

  • Is simply swamped with the increasing numbers of complex patients on their books needing to see multiple specialists,
  • Have little time for the “referral paperwork” required to be faxed to multiple department
  • They have to know the best specialist for you.
  • After you are discharged from hospital you are often on your own to coordinate your own care and follow up.

Paperwork

  • Clinicians have to spend a lot of time on administrative tasks, reports, many related to getting paid, covering their risks of litigation, demonstrating accountability, justifying their positions.

 Improvement in health literacy supporting patient centred care, enhanced Communication provider to provider, education and support to balance all your treatments, Full Coordination of care, Support sharing your information and agreed action plan