Rising ER wait times are just one of a host of warnings of bad things yet to come; unless we can change thy stem to one of collaboration!
(Technology innovation alone is not the answer)
In a recent publication Aiden Feng MD notes the specter of ongoing rises in ED wait times across the U.S., and how this is one result of, and a ‘red flag’ warning about multiple other disrupting issues increasingly threatening our entire healthcare system and workforce!
The article goes on to tout many technological and innovative solutions that could and are being applied to combat this and other healthcare system issues, but notes that addressing our healthcare system challenges requires comprehensive, system-wide approaches, not just isolated fixes.
He points out, in fact, that despite a huge rise in technology adoptions, healthcare system productivity has actually declined 13% since 2001.
Huge Technology Advances – but still Failing Productivity?
These “productivity” failures should be an additional ‘red flag’ warning of an evolving crisis within our healthcare system. However, many of our ‘leaders’ and stakeholders still continue to laser focus on productively and profit as chief healthcare drivers, and initiate isolated interventions targeted to these goals.
That isolated ‘Laser’ focus speaks to the root cause of much of the turmoil, disintegration, and failures in our current system and workplaces, a crisis that continues to expand unchecked.
Addressing the Crisis – Challenges to Improving Healthcare:
In order to obtain system-wide improvements within our current healthcare system and workplaces, we must, as a society, stop ignoring and begin to come together to collaboratively address a multitude of disruptor challenges now plaguing our healthcare system. The huge number of, and the critical challenges posed by this host of expanding disruptors offer further ‘red flag’ warnings about the fragility of our current system and the now urgent need to begin to address these issues.
The Scope of this Crisis – Numerous System Disruptors:
These disruptive challenges include: A healthcare financial system that incentivizes and compensates for quantity (productivity – volume) of care rather than quality of services provided, (a negative driver contributing to all other disruptor issues).
The accelerating shortages of doctors, nurses, mid-levels and other ‘hands-on’ healthcare workers – as more and more exit the system, or choose other careers, rising burnout rate, disenfranchisement, accelerating worsening in worker physical and mental health with rising suicide rates, the spiraling ED/hospital boarding crisis, overwhelming clinical workloads, prior authorization conundrums, an exponentially expanding (3,200%) managerial class that increasingly views clinical workers as oppositional (Suis versus Scrubs) to ‘company goals,’ leading to ‘moral injury’ workplace conditions, accelerating, unchecked workplace violence – with healthcare now ranked as the most dangerous profession in all American industry, ongoing legal obstructions to addressing clinician non-compete clauses, increasing delays and denials in patient access, a rural healthcare crisis, continuing hospital closures and/or reductions in services, increasing political entry into clinical decision making, the ever escalating cost of U.S. healthcare (4.8 trillion in 2023– the most of any industrialized nation) – but with worse outcomes than any other similar country, with the exploding burden of these advancing healthcare costs further accelerating our national debt, and a host of other disruptor issues.
A Solution?
To achieve comprehensive improvements and whole-system stabilization, it is critical that we MUST have enhanced, across the board collaboration and cooperation among ALL major healthcare stakeholders and society, working together to address and correct these disruptor issues that threaten our entire healthcare system.
However, as healthcare increasingly becomes one of the most rapidly rising economic sectors in the U.S. economy, we currently see exactly the opposite of improving stakeholder collaboration.
How Did we Get Here? – The Stakeholder ‘Oppositional’ Conundrum:
What we see, in our current system, are many of the major economic stakeholders (Insurance Industry, Big Pharma, PBMs, Federal and State Governments, Healthcare Industry Leaders, Corporate healthcare & Equity Healthcare ownerships, etc. ) increasingly locked in struggles for greater market share and profit, wanting a bigger slice of the economic healthcare “pie” – such increased slice that they must wrest – in largest part – from other stakeholders, thus creating an often-completely oppositional malalignment of directly conflicting goals and interests. In all this the patient is now increasingly viewed economically as a “commodity” and an assembly line production ‘product’ in these ‘slice of pie’ markets share struggles.
Under this type of oppositional environment, system disruptors continue to appear, flourish, and expand unchecked.
One Result – Healthcare as a Target for “Big Business”!
The current disrupted status of our healthcare system has made healthcare a tantalizing target for big business. Increasing numbers of historically non-medical mega-businesses have now entered and are entering the healthcare sector, buying up and consolidating healthcare systems and thus expanding the oppositional market share battles.
Distressed, disrupted businesses, with high financial potential are prime targets for successful mega-businesses looking to expand. This is what Private Equity purchases are all about! These companies purchase and enter distressed market sectors while confident, per their previous successes, that they bring with them a better business model and can turn these distressed sectors around, or failing that – sell off the parts – profit either way!
Thus, these non-clinical leaderships of these successful historically non-medical businesses are highly incentivized to run their new healthcare acquisitions by applying their same ‘tried and true’ management formulas that they have so successfully used in dominating other manufacturing and production sectors.
This view further encourages an evolving practice of having no ‘practicing’ clinicians seated at the table of these decision-making boards, seeking instead to seat non-clinical “captains of industry” who have demonstrated profit-making success in other market sectors. (there are also evolving legal reasons for this) These non-clinical boards increasingly show little interest in seeking direct input from the clinical workers they now govern, (“why should we listen to clinicians, they represent previous failed business models”), instead receiving input only from their expansive on-site management teams who now more frequently view clinicians as oppositional to company goals.
Conditions are further aggravated by the fact that most physicians (and others who would advocate for patients and the workforce) as now employees (‘cogs in the wheel’) and no longer have a seat at the decision-making table and thus no voice to speak out about their patients and the safety of, or worsening conditions in their workplaces.
In all this, patient care again becomes increasingly viewed from a corporate standpoint as another assembly line productivity sector that can be best managed with similar market rules of engagement.
Where does this all lead:
In the end, such oppositional market share expansion, with conflicting goal-seeking, profit-taking, assembly line productivity mentality, “slice-of-pie” in-fighting, and ‘I have a better business model’ attitudes within our current system by those who we would anticipate should be taking the lead in repairing and stabilizing the system, only leads to increasing disruption and further fractionalization.
So, until and unless we can change our system to one that promotes global collaborative efforts by all our healthcare stakeholders – we are much more likely to experience further degrading of the current system, with continued or worsening disruptive workplaces, further exodus of current doctors, nurses, other healthcare workers out of healthcare, increased turning away of bright young minds from clinical careers, increasing moves towards unionization by those workers who remain, further declines in system & workplace ‘productivity’, and further accelerating costs, while we face progressive increases in patient lack of access and greater worsening of patient outcomes! A general failure of the system!
Disclaimer: views and opinions expressed are the author’s own and do not necessarily represent opinions and positions of the author’s employers and affiliates.
References:
- Aiden Feng MD, “Rising ER wait times signal larger health system challenges”, com, Sept 2024, https://www.kevinmd.com/2024/09/rising-er-wait-times-signal-larger-health-system-challenges.html
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