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"Are patients getting sick or cured in hospitals?''

I am willing to write a magazine article about this topic:
"Are patients getting sick or cured in hospitals?''
This is mostly about the hospital environment where the patient stays for days weeks and even months. Here in my country, patients are left as objects where health professionals visit them for a short period of time, do their job in minutes and then disappear! Patients spend the rest of their time with pain, listening and watching other sufferers , and waiting for death.
They are isolated from the world.
When we visit relative patients in minutes, we feel the bad conditions they live in, talk for minutes and then forget about it. But they, patients, are the ones who have to stay there and try to cope with it.
Obviously, this is not right and must be changed.
Please help me by 'donating' ideas!!
What are the bad things you notice in hospitals?
What are the good things that you notice in hospitals and is done somewhere in the world?
What are the good things that you notice(from your ideas and imagination)?
If we had to make a non-profit organization to deal with this, then what will it have to do?
This is mostly about fixing the hospital's environment and making a better place where patients can enjoy their stay!

social workers, clowns, magicians....anything,, I respect all ideas!

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    Feb 24 2012: Another TED poster once described patients as being 'transients in the system' and that says a great deal. The system is elevated above the patient. The patient will depart, either alive or dead, but the system will remain, and the focus is on operating the system, not the wellbeing of the patient.

    Look at how hospitals are run - bureaucracies with lots of administrators and boxes to tick and technology to look at. Then try and find which individuals have direct personal responsibility for patient wellbeing. You will find that the system is designed to protect the individual from any accountability. That's the fundamental flaw in how healthcare is delivered - health has no priority and it's no-one's job to care.
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      Feb 24 2012: I agree with you Anne- I believe it is the system structure (hospital hierarchy and vertical department silo model) that is one of the core problems. Add to this that the individual physician practice model is just as outdated as the hospital system structure and you end up with what we currently have in health care today. We can design a new system structure for care, but it is not easy because the current large organizations that dominate health care today are benefiting from the status quo.

      We have recently started a new academic medical center in a new system structure for health care (it is a start-up, only five divisions so far). Physicians are part of teams that work with definable groups of patients (and patients and family members are part of the team). With the help of a new professional, the patient care manager, each team evolves care communities that work together to help each other develop caring, loving relationships. It is through these relationships that care can be compassionate as well as high quality and efficient. Although there is an increased cost initially to implement this model, we are seeing that the efficiency and quality that can be gained in care, and the lack of bureaucracy, can potentially lead to a system that is actually much lower cost, while providing better and more compassionate care. In our new model, it's everyone's job on the team to care and there is never a hand-off. We start a new residency training program in July, so soon we will be training physicians in this model.

      As far as the original question, the answer is both- patients get sicker and are cured in hospitals. But, we should and we can do much better. We need to change our thinking (from reductionist to complexity science thinking) and change our models (from hierarchy and vertical silos to small teams and care communities).
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        Feb 25 2012: Bruce
        I am interested in this model. Do you have a reference?
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          Feb 25 2012: We don't have a publication yet, but if you would like to email me (bramshaw98@yahoo.com) I could send you some of our business plan- most recently summarized for a CMS grant application. Thanks for your interest, Bruce
      • Feb 26 2012: Bruce, this sounds great, I am also interested in learning about the model you created!

        It is interesting the many names patient-centered care has- some people call it relationship centered and some patient/family centered (I believe family is implied and does not need to be in the name)

        I think the way I would combine both relationship centered and patient centered programs is to call it a participatory health care program. . . I know it seems silly to care about a name, but with so many names it seems more fragmented, therefore less seen

        What I'm interested in is how you are measuring outcomes . . . I've seen research that looks at objective measures (survival rate 1 year post MI) was higher with a higher patient perception of patient-centered care (participatory care)

        Participatory Care as Starfish Organizations:
        I read a fantastic book by Ori Brafman and Rod A. Beckstrom The Starfish and the Spider, rather than considering what you are doing as bottom up, it sounds more like the starfish metaphor, you can read it here:
        http://www.starfishandspider.com/index.php?title=About_the_Book

        Healthcare is more complex than people realize, and the impact of how we manage health is more preverse, reaching all facets of daily life, even if you are alive and well as an individual- the excessive money the nation needs to spend alone impacts the education our children recieve: http://www.ted.com/talks/lang/en/bill_gates_how_state_budgets_are_breaking_us_schools.html
        • Feb 27 2012: Agree wih the above. Having spent some time in healthcare, I have discussed with hospital boards how hospitals organisation should be switched from speciality-centric to patient centric. Hospitals do recognise the importance of care pathways but performace (especially financial performance) is seldom linked to care pathways. Typically a hospital will measure it's performance al the level of specialty departments and quality performance is either measured at the same level (which is useless) or at the level of care pathways wich is disjointed with financial performance i.e. the patient's results have nothing to do with financial results. In sept 2011 in the harvard business review, you'll find a similar argument made by Robert Kaplan and Michael Porter who then get into a detailed description of how performance could be tracked at a deep level of detail. I am not so convinced in the necessity of deep granularity of data to manage performance but the point about patient centric org of hospitals by care pathways is spot on
  • Feb 26 2012: I know exactly what you mean. I worked for awhile at a nursing home, and saw, of course the lassitude, loneliness, deppression you talk about. One thing that I thought of : an organisation, national would be good, of volunteers who spend time with people who are long-term, or even long-ish term in hospital. For those who can, a meeting room where activities can be done, for people who cannot get out of bed, personal visits by people who have been informally trained to know what 'chases the blues', you know ; reading to people their favorite books, playing scrabble, but spending real time. The brief visits that you mention are sometimes the cause of more misery than hope, as they are too brief, and only remind the patient of their situation. An ambitious organisation would broadcast itself and locus public awareness on this problem, alerting churches and other organisations to follow suit in these activities, and hopefully stimulate within some hospitals arranging activities, options for patients other than laying in bed. Mostly, I think, public attention being directed toward what you are talking about, and I think your bringing this up is commendable. Good luck to you.
  • Feb 26 2012: I think that overall it's about shifting hospital care from looking after a condition to looking after a human being. Hospital infrastructure is the starting point and that is certainly a massive issue in some Southern Italian cities such as Naples. And yet, if we were prepared to care for a human being instead of a disease and did all that goes with that, we'd massively improve patients condition. You certainly don't go to hospital to watch a movie or play a cards tournement thought there wouldn't be anything wrong with that if that was possible. But a patient should be looked at holistically, especially if hopitalised for cronic conditions. E.g. if I went to hospital and they made me participate in my nutrition and in understanding my overall condition, I'd feel more responsible and participative of my health. Also, there is a problem of incentives: hospitals get money on the basis of the number of beds they keep full and especially bad hospitals where people don't want to go, will hold patients in preparation and after surgery for far to long.
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    Feb 25 2012: It's never been easy to talk about what is right or not. We do don't have enough resources to share for all people. So my point is you got money, the doctor will serve you the best. If you don't, just forget it, he just comes to you for a while as his responsibility then go. Every where in the world is the same.

    So i suggest the answer: Don't try to get hurt or sick so that you don't have to go to hospital.
  • Feb 24 2012: You may want to look into the fact that, when patients are made sick by hospitals, the patient and their insurance companies have to pick up the bills for the sickness caused by the hospital AND the hospital is getting richer by making the patient sick because they need more hospital care than, if the hospital had not made them sick. I've heard of 2 or 3 illnesses people frequently pick up in hospitals and they are sometimes fatal. Staphlococcus. Streptococcus. And there is another common one. You may want to check out what Rebbe Nachman of Breslov says about going to visit doctors. Medicine is one of those fields that specializes in negativity, i.e., they function mainly within the negative realm of trying to bring people from a negative state of being up towards neutral or zero. Comedians operate within a positive realm of assuming people are at neutral and working to raise their well-being to higher and higher states of feeling good. Perhaps if medicine operated within the positive realm, it would be more effective. Also, of course, there is the problem of the pose of "authority" the doctors assume. I wonder to what extent doctors are motivated by inadequate egos, money and stuff like that. Medicine seems to be a big business that is aided and abetted by another negative industry that sucks money out of people by provoking fear- the insurance industry, the pharmaceutical industry. There is big money in medicine. Money is a big motivator in all parts of the medical system. Too bad so many of our insittutions are based upon manipulating human behavior by provoking fear.....religion, for example. We need to base our institutions and systems on positive assumptions. When in doubt, assume positive. Happy Today.
  • Feb 24 2012: In the US. The institute of medicine put a call to action to nurses who may not change the curing aspect of healthcare but certainly influence the healing aspect of healthcare

    I believe patients hold the keys to cure or get sicker- I also believe more time alotted for a nurse per patient (hour) would help increase the chance the patient find's their inner resources and comes out on the healing/cured side of things

    Things have to change
    • Feb 24 2012: Do you mean that it is the patients own personal responsibility to be healed, or that we just have to access their "keys"?

      If it is the first, then all I can say is that this is an unreasonable expectations of our sick patients, we don't have control over our treatment, so we don't feel like we can take control over the situation as a patient of a hospital.


      One very easy thing to improve would be to remove much of the paper work from expensive doctors and put that responsibility more to a secretary which will be beneficial economically and hopefully get doctors more motivated.
      • Feb 24 2012: Yes, Daniel - paper work takes a lot of time that we can use more effective... Also what a thing I've noticed - is that many young doctors and residents that are not yet in such a "routine feeling" have a lot of ideas and motivation - but they can not do anything because nobody believes in their rights. Everybody thinks that they do not have enough experience to make an own opinion... As a result they are often stopped. How is this point in yours countries?
        • Feb 26 2012: I know the feeling Elena, the feeling of inadequacy has swept through my mind more than once since becoming a nurse in the last year. . .

          I have felt that without enough experience to validate my ideas I will not be taken seriously, or perhaps I am too optimistic- this feeling has held me back on a recent oppurtunity offered to me to be a part of a national 'practice committe'
          I don't know how I allowed myself to not see how I deserved it and would bring a valuable 'fresh eye' to the table

          . . . it was an honor to be asked and now I'm too embarrased to have not accepted to even feel good about having been asked

          next time I won't help close the door of oppurtunity. lesson learned
          -----------------------------------------
          http://www.ihi.org/offerings/IHIOpenSchool/Pages/default.aspx
          there are many ways to use your fresh eye, check this 'open school' out
      • Feb 26 2012: Daniel, I am referring to accessing their 'keys'
        I copied/pasted this from a question I posted a while back:

        What I would like to see is a tool developed to help a patient identify their needs then allow them to see where they are and where they are going in what I would call their Wellness Story. I would call this a Wellness Mapping tool to allow patients to show us where they are in wellness according to their personal goal of what wellness is to them. This tool would allow the nurse to understand the patients perspective of wellness, not what we value, but what the patient values.

        The tool would allow us to advocate for the patient in developing a plan the patient felt they had the capacity to continue. "People are not motivated by fear; yet something tangible in their life" (Thomas Goetz). The purpose of the tool would be to give the patient a sense of empowerment, "And the day came when the risk it took to remain tight in the bud was more painful than the risk it took to blossom" (Anais Nin) .

        People are highly intelligent and highly individual. We can not expect to tell a person what they need to do to gain health rather be a resource- a light in their darkness, "And so, I give this spark of what is light to me, To guide you through the dark but not tell you what to see" (Unknown Author).

        Because we have to change the way medical care is implemented

        http://www.ted.com/conversations/4461/is_it_possible_to_screen_patie.html
  • Feb 21 2012: Before we are educated, and before we learn "facts", we feel, we even know that there is more to life then just our physical body and brain. We all were mini-scientists who explored our surroundings, trying to make sense out of it all based upon observations and conclusions. With new information we had to revise our previous conclusions, like the alienating sensation we had when for the first time imagining a life without souls. But we grow wiser, we become socially adequate and we accept the fact that there is no place for a soul in science. We accept it so much that we even start to exclude the soul when attempting to heal humans from both physical and mental diseases.

    When observations that questions our scientifically objective reality appears - placebo and nocebo - most of us will scratch the scalp and wonder how we can make this fit in to our already well known and scientifically established facts, because it really would be uncomfortable to reconsider not only our view of the world, but also our view of our selves - and most importantly - reconsider the concept of "soul".

    If we consider reality and facts to be subjective and personal we may actually gain something scientifically. If reality doesn't exist before we project it, we could apply all sorts of unexplainable phenomena, including placebo and nocebo, to this thesis.
    The best example of benefit would be that we can unlock new ways in which we meet, diagnose and treat patients at hospitals. If we truly can master this, we will be able to influence a persons reality in addition to influence the biological robot that we nowadays through the narrow lens of what we call scientific, "a human".
  • Feb 26 2012: I would say in the Hospitals I have visited both as a patient or as a visitor, the best is applied to have patients recover and get better. It is obvious that in every situation there is an exception to the rule, whether it involves Hospitals or the Government to Manufacturing to Nature, my point; simply a higher percentage of good for now is the end result.
  • Feb 26 2012: Since hospitals, like most insitutions in our society, are motivated by continuously increasing revenues, it is in the self-interest of hospitals to make patients sick, since it results in added money income to the hospital from the patient and their insurance companies. Hospitals assume no financial responsibility when they are the cause of sickening their patients. I do not believe they do it intentionally, but it does happen quite a bit and there is no financial incentive for the hospital to curb or eliminate the problem. And we all know how potential money income affects people's behavior.
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    Feb 26 2012: To an extent I have reservations about an 'everyone working together' approach. It's good in that it brings together a breadth of knowledge you wouldn't get from an individual, and in a good group it tends to force the individual specialist to think think things through rather than take short cuts to a decision.

    The deficiency I see is that if you make a team responsible rather than an individual, then no-one has the job of ensuring things happen the right way, and taking action when things go off course. Even the best of teams needs someone to take that role, and in larger scale organisations it is absolutely critical most of the time. Why? Without personal responsibility it's too easy to hide behind team decisions and actions. And if no-one is accountable, the patient suffers.

    I'm not talking about status, but authority does come into it. The person with accountability needs the authority to challenge a team member with higher status.

    You can see this model working in project structures, where a project manager may have matrix responsibility for a team which includes people who are more senior or more technically qualified than the project manager. That said, I'm not in favour of injecting additional administrative roles into patient care. From what I've seen, health provision has veered too far in the bureaucratic direction already.
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    Feb 25 2012: Bruce, A few years ago the UK had the concept of multidisciplinary treatment, which sounds similar to what you describe. One problem with the current mechanistic approach is that it encourages too much narrow specialism, and the mindset of the specialist is to dismiss as irrelevant anything which is outside his domain. In the medical context that amounts to ignoring symptoms which demonstrate serious problems in other domains. The multidisciplinary approach went some way to compensate for this by including multiple domains, and also healthcare practitioners who were 'lower' in the hierarchy than the specialists. That went some way to ensuring that the patient's symptoms were analysed, as opposed to today's more common approach, which amounts to specialists picking out the systems which interest them and discarding everything else.
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      Feb 25 2012: Hi Anne- Yes, I'm familiar with many of the attempts of the UK system to address the health care issues. They have all failed (at least for the most part- I know some have had limited success due to the extraordinary efforts of individuals who are passionate, committed people) due to a reductionist science (fragmentation) approach. It is necessary for the specialist to relinquish control of their knowledge (codifying it for all others to learn from on the team) and be driven by the purpose to improve care for identifiable patient groups. Everyone working together for the purpose of improving care is the core of the solution. Our current health care system structure (individual physician practice and hospital hierarchy and vertical department silos) does not support this care structure- that's why everything starts with a new system structure. The attempts at multidisciplinary care in the UK never included a structural change in how care was delivered- that is why the specialists had the ability to function autonomously. In our model, no one, not even the specialist, has any more authority or status than the patient, family and anyone else on the team.
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    Feb 24 2012: It's an interesting question. And merits consideration of the meaning of "cure." There a woefully few diseases that can be truly cured in the common sense of the word. Surgery and antibiotics are 2 of the most effective ways to achieve a "cure" but even these fail at times. When cures occur in the hospital they can be amazing -- but a key determinant can be how sick someone is by the time they get there. Penicillin, for example, can be a miracle when its given at the right time, early, and in the right disease. When given too late, or for the wrong microbe, its a complete dud. For cures, context can be everything.
  • Feb 22 2012: Only a magazine artilcle??

    Conditions are no different here.....except as Linda said, that when you have an operation, or deliver a baby....out you go as soon as possible, unless there are complications.'

    From reading your intro, I pictured an elderly patient.....because they are the most vulnerable.....younger patients get up and walk around and talk with nurses and patients in other rooms (unless they aren't able to move).

    My elderly parents have been in hospitals several times, and we do not depart from the hospital room, taking the day in shifts. Because we are aware of conditions there, we know that a hospital stay can have devastating effects on the emotional well-being of our loved one.

    Also, when friends are in the hospital, we do the same....taking turns, to insure that they feel loved and cared for. Sometimes it's a nice phone call that lasts a long time, if the hospital is far away.

    I dislike organizations to deal with the humanity of living.....The motivation for this kind of activity should be love for humankind.

    Those students in middle and high school or university who have empathy for the sick, or who are going to study some kind of profession in sciences/medicine could volunteer their time.....and most people are affilitated with a church, shouldn't the religious leaders be making weekly visits to hospitals? Don't most places of worship have a slot where they announce who is sick and in the hospital giving the hospital name and room number, so everyone can visit the fellow worshipper?

    Overall, IMHO people are scared to be around the sick and elderly for too long. They quickly visit, and go away thinking they did their share. Not realizing it could be them in that hospital bed in the future.

    The best thing to do is set the example ourselves of what it is that needs to be done, and invite others along, and then watch it spread.

    This is a very serious topic...not to be taken lightly. Good health to you!!!
    • Feb 26 2012: It is not easy to be with the suffering of another

      I feel nurses have an oppurtunity to reach out to loved ones visiting by helping them helped their loved one

      It can be difficult for a lot of people to "do nothing", and some loved ones do not know the value of their mere presense [from nothing comes something]
      • Feb 28 2012: "I feel nurses have an oppurtunity to reach out to loved ones visiting by helping them helped their loved one"

        What a great way of thinking......it would be wonderful to see this.

        Here in S. Fla, unfortunately, many of the nurses do not speak spanish....and spanish is the language spoken by many of the elderly in hospitals. The language barrier sometimes affects the hospital experience of many an ill individual.

        That is why I do not like to ever leave my parents alone at hospitals.

        Thank you Autumn for the wonderful reply.

        Be Well.

        Mary
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    Feb 22 2012: In the US it used to be that way. Then it got too expensive and people figured if your going to be sick anyway, you might as well be sick at home. Hospital stays have decreased considerably in the past decades. So for instance, it used to be if you had a gallbladder removed, you were in the hospital approximately 2 weeks. Now, with new laproscopic procedures and better results, you can be out of the hospital and recuperating at home in a day.

    So the best thing you can do for patients in the hospital is to take them home.
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    Feb 21 2012: Activity of some sort for the patients to get involved in is, I think, a good place to start. One could grade patients based on their ability to interact with the world through diagnosis and conversation, and then have a setup of activities suitable for the individual patient and his/her condition. In my experience I am happiest when i'm engaged in some sort of activity and not really aware of myself or anything else but the task i'm performing. Considering the fact that ones joy of living is linked to, and can help improve upon medical conditions, this might be a win-win situation where patients get better faster releasing resources the hospital can use on other patients who might be waiting.

    Just a shot of the top of my head. First thing i thought of after reading your post. Good theme :)