There is a classic episode of “Laverne and Shirley” where they are marching around their apartment chanting “We must, we must, we must decrease our bust. We must, we must, we must decrease our bust.” If I recall correctly they were attempting to transform themselves into the role of men, so they could compete for some job or new role at work. If you aren’t familiar with Laverne and Shirley, they were two progressive, iconic women who lived together in an apartment in Milwaukee and worked at a brewery during a time when this was not commonplace for women. I loved this show when I was a young girl, because it represented for me — women who were always pushing the envelope and instigating change. Whenever they tried to be someone they weren’t or do something that went against their core values, it completely fell apart, but in a comedic way, leaving the viewer in a fit of laughter (i.e. stiches).
Terms like ‘change’ and ‘decrease’ are very relevant to what the healthcare field is going through right now. Yet the stakes in this change are so high and the need to decrease inefficiency so important, not even Laverne and Shirley could make this funny.
As a consultant who has had the opportunity to work with numerous organizations, big and small, private and public, for-profit and not for profit, I have observed the group chants about what we need to do to change so that we can compete. I have seen the attempts to implement cosmetic or superficial changes so that they appear to be different from their competitors. I have seen the adoption of strategy that is antithetical to the organization’s mission and core values result in colossal failure. Change is hard. Sometimes change is imperative and sometimes change is not such a good idea.
Our nation is undergoing the most significant change it has attempted to make in health care since the implementation of the Medicare program by President Johnson in 1966, which began with 3.7 million beneficiaries. In 2011, the Center for Medicare and Medicaid Services (CMS) reported 47.6 million enrollees in the Medicare program which reflects an unsustainable growth rate given our nation’s financial circumstances. In 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA), a monumental piece of legislation that seeks to significantly change the way in which our government’s health care programs are administered, delivered, financed, and evaluated. The goal of PPACA has been referred to as the Triple Aim: (1) better care for individuals; (2) better health for populations; and (3) improved efficiency resulting in lower per capita costs. The only way to achieve these aims is to make fundamental changes in our health care delivery system, including the integration and coordination of care, as well as the adoption of technology and services that improve quality and accountability.
In the world of the hospital, this new or transformed model is exemplified by The Acute Care Continuum. Using the efficiency gained from working together, hospitals can deliver high quality, efficient, performance-based care in concert with participants such as emergency physicians, urgent care centers, hospitalists, and intensivists. The vision and core of The Acute Care Continuum aligns with the direction the nation is going as it transforms from a disparate, fee-for-service model to a better care, better outcomes, and more efficient model. So, the good news is that as the nation and others are in their boardrooms, conference rooms and apartments trying to figure out how to make the new suit fit, The Acute Care Continuum is naturally evolving by the day.
Those involved do not have to make changes that are juxtaposed to their core values or conflicts (trying to decrease one’s bust), since collaboration on behalf of the patient usually fits within the fundamentals of patient care. Importantly, these changes taking place to create a true Acute Care Continuum are not at risk of leaving the audience in stitches. All entities involved have the opportunity to perfect and expand the service delivery model, so that they are well positioned to serve as change agents and leaders at the local, regional, and national level during the national healthcare transformation.
The full implementation of The Acute Care Continuum is the pass that opens doors for healthcare delivery systems in this country. I commend those working across The Acute Care Continuum for having the foresight to make leadership, collaboration, quality and performance the pillars for the future. I can only hope that as we look back on these times 30 years from now, the healthcare field has advanced as much as women’s role in the workplace has since the days of Lavern and Shirley.