Healthcare in America is broken but still functioning because gallant care providers, mostly nurses, are holding it together. However, with Covid, the cracks in the system have become chasms that, to repair, require true transformation rather than the iincremental change/improvement efforts that have been ongoing for decades.
It is not well understood in healthcare that the vast majority of problems we currently face are actually systems problems, mostly on the front lines where care is actually delivered. Care providers can do no better than the systems allow, no matter how much dedication and effort is expended. Of course, this herculean effort takes a huge toll on those care providers working in poor systems.
The natural stress that accumulates in poor systems that resist change in a changing environment is passed on to the people who have to work in those systems. This dynamic is invisible to healthcare, but, invisible or not, is the major source of personal problems for front line care providers. These problems include burnout, stress related disorders, low morale, absenteeism and a host of other issues. This stress is also passed on to patients, creating another extensive list of issues.
With now chasms emerging from cracks in the system, the holding actions of dedicated care providers are running on fumes. It’s time to jettison the stale and weary concepts of change or improvement and leap to where we really need to be—genuine transformation. In addition, to create this transformation, we need to be thinking of a whole new model for healthcare transformation itself.
This new model should be bottom/up, systems-based, easy to implement by front line care providers, driven by Nobel Prize winning systems science and not SPC, use a “pull” strategy rather than legacy “push”, and scale organically, owned by those closest to the patient. I know. This is a mouthful but this is the model that is already working in the vanguard of hospitals that will become case studies for the much-needed transformation of the US healthcare system. Nurses and nursing will, for the most part, lead the coming transformation. In the process, nursing will take its rightful leadership role in healthcare and patient advocacy.