High-Tech Healthcare Still Missing Teamwork

etwilsonBy Edgar Wilson, Independent Analytical Consultant
Twitter: @EdgarTwilson

All the technology in the world won’t turn rugged individuals into a functioning team.

Experts across the spectrum of business and healthcare alike are singling-out the central problem withholding the full value of emerging technology: management.

“We have moved greatly in the field of management from management based on intuition certainly, over a long period of time, to a management based on evidence (evidence-based management),” explains Northeastern University’s Professor Carl Nelson. “The same thing is happening, and has been happening, in the field of medicine—so-called ‘evidence-based medicine’.”

Though Nelson typically teaches on international business and strategy, his expertise is seeing increased demand among students–some new to healthcare, some pursuing continuing education–who recognize the need for a new leadership and organizational approach to delivering superior care.

The evidence for best-practices exists, for instance, but disseminating it still occurs on an individual basis all too often. The power of the individual manager is limited in an industry where teams are necessary. This is a systemic issue in medicine, with a systemic solution.

The very features that make prevention and health maintenance so powerful are the same that preclude coordinated care from occurring: an ongoing relationship between patient and physician, wherein the patient can bring questions, non-emergency complaints, and seek greater health wisdom and expert observation. Primary care providers act as individuals, executives in charge of monitoring and managing each of their patients’ health. CEOs of personal health, in a sense.

Unfortunately, the compensation models reward individual clinicians who prioritize higher volume, not better individual care. While from an outcomes perspective, it would be better to make patients players in their own healthcare teams, instead they are consumer-cattle, herded en masse to ensure volume payments can proceed without interruption.

It is not merely clinicians doing the herding, but rather the entire system of insurance, reimbursement, and yes, the federal government’s many tentacles—but the net effect is that when it comes to primary care, there is simply not enough team-oriented leadership, coordination, or resilience.

Resilience, in this case, is a term perhaps best-defined by General Stanley McChristal through his book, Team of Teams. As General McChristal explains, resilient teams at their best, are the close-knit groups of highly skilled individuals who communicate, coordinate, and achieve success as an independent unit. The important feature here is that from a managerial perspective, they don’t look to a single leader for direction, but take action collectively. It requires trust, training, and of course very deliberate communication, but the results are profound. From NASA shuttle crews to ER surgeons, dealing with rapidly changing situations and life-or-death decisions effectively depends not on hierarchal leadership, but a sophisticated form of groupthink.

The many models—including in emergency care—demonstrate the power and adaptability of resilient teams.

Outside of the emergency room, healthcare is disengaged, centralized, and driven by the outdated managerial structure that puts an executive at the top of the decision-making chain. In terms of managed care, this means patients either subject themselves to the orders (when it comes to health, ‘recommendation’ is often little more than a euphemism) or try to go it alone.

“People regularly consult the internet, WebMD,” explains Nelson. “They’re confused, they’re looking really for a healthcare system that can guide them through these extremely troubling circumstances and times.”

Patients are willing to put their faith in technology, but what they really need is a better sort of team focused on their care—and they need to be a part of that team. The clinician can provide critical context not just for whatever information may be gleaned from online sources, but more crucially, for the information increasingly being presented through accessible Electronic Health Records (EHR). The human filter makes the technology relevant, and effective–not the other way around.

Technology is being peddled as the solution to everything: margins will be lifted by the application of data science, bolstered by the point-of-care EHR system. High-performing individuals will accordingly be compensated commensurate with their demonstrated (and digitally documented) clinical value. Patients will become more engaged in their care by having access to their records; clinicians, in turn, will be compelled to consider that their patients will have access to all of their notes through online EHR portals. And of course, care will be better coordinated once interoperability of these magnificent EHR platforms is achieved.

The emerging technology has the capacity to support these and many other transformations of care, certainly; but not on its own. Adoption is unfortunately still being hampered and helped in equal measure by the strength of clinical personalities: individual physicians, even in hospitals across networks, are taking a personal approach to using (or not) their shiny new systems. They hire transcribers to convert their paper and pen notes; they access a separate interface than the rest of their staff; they bring the new high-tech model into their pyramidal structure of care delivery.

Individual adoption is not enough; the system, to succeed, will require teams to coordinate their use of technology, their communication through technology, and their care integrating an ever-evolving suite of data and technological tools. The disruption currently occurring could be mitigated by teams learning and adapting as units, rather than individuals bringing their disparate opinions and prejudices to bear on each feature of the digital revolution.

Digital integration won’t happen without the human systems first shifting toward a less hierarchal structure of resilient teams. A health system comprised of such teams can not only deliver better care, but can adapt as the technology it uses continues to evolve.