Friday, April 1, 2016

Hospital  Immersion – Seeing Is Understanding
Sometimes you can’t explain something. 
You have to see it to understand it, like  fiendishly complicated deeply nuanced  hospital care.  

This was the premise of 2 physician hospital board members,  who created “Immersion Day” for Mission Health,  a 763 bed medical center in Ashville , North Carolina ,  a $1.6 billion  enterprise.
 The 2  physicians describe the day in the March 31 edition of the New England Journal of Medicine – “Immersion  Day – Transforming Governance and Policy by Putting on Scrubs.”
Their idea was simple and obvious -  Have hospital board members, journalists, legislators, and regulators put on hospital scrub suits for day and expose them to the workings of the hospital to deepen their understanding of the workings of the hospital, its complexities, and its costs.
As an American Indian once explained,  “You have to walk a mile in another man’s moccasins to get the smell and feel  of what he does.”
“Immersion Day” begins at 7:30 AM with a orientation and a signing of confidentiality agreements, followed by exposure to pre-op care, listening to patients’ stories, then watching the surgical team put the patient to sleep,  witnessing an operation,  then joining rounds in the intensive care unit, observing critically - ill patients, talking  there with nurse, hospitalists, and case managers, then going to open-heart surgery suite,  observing an operation, then rounding with specialists,  and watching hospitalists struggle with entries into electronic health records or doing beside procedures,  and ending the 9 to 12 hour day in the emergency room, as witnesses to the overcrowded  controlled chaos with its unforgettable moments.
Board members called their Immersion Day as “eye-opening  and endlessly fascinating, “ “unforgettable and humbling,” “the best-spent day of my life,” and “ Iearned more about hospitals and health care in 10 immersion hours than 6 years sitting on the board.”
The 2 doctor authors conclude”  Deep immersion in the work of our health system has strengthened governance and engendered trust in our community, staff, and physicians, while elucidating health care for policy makers.”
Once board members – manufacturers, investors, and  bankers -  have been there and seen that, they know how a health system works. And they understand the system’s complexity, the human nuances,  the workflows and the choreography , the opportunities for error, forces behind increasing costs, and why human good flows from serving all patients regardless of ability to pay.   Knowing intimately how the health system  transforms the system by humanizing it and it creates better working relationships between the hospital board and the physician staff.  

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