Abstract
Dear Editor:
I just boarded a plane to return home from Boston after attending an academic leadership conference to better prepare for my new role as chief. Several years ago I noticed “systemic” problems including poor communication and fragmented care, with the greatest deficiencies in end-of-life care. No longer was it enough to treat the critically ill patient, I wanted to treat the critically ill system. The U.S. healthcare system spends more money on healthcare than any other industrialized nation in the world, yet despite our large investment, outcomes are among the worst. Looking around the room at the 30 or so brilliant minds at the leadership conference, I pondered who in the group would seek to find answers to these very difficult problems. We learned in our course to always start with a mission and vision. In addition, we studied operations and finance, differential accounting, Toyota Production System, Six Sigma process improvement, leadership emotional intelligence, and the complexity of cross-coordination responsibility centers. Finally, we touched on the most unsettling and surprisingly controversial of all topics, patient experience. Frustrated with a case presentation, the team complained that each patient is unique—not widgets. Our population comes from different cultures, with different values, decision-making styles, literacy, goals, social complexities; no two patients are alike. Someone in the group coined the term “snowflakes,” unique and beautiful, and no two are alike! How can the healthcare machine adapt to the uniqueness of a patient while both increasing quality and decreasing costs? The person next to me whispered, “finding the answer would be the holy grail of medicine!”
After much contemplation I realize I found my holy grail, my mission and vision. It is palliative care, which aims to close the gap between the care patients want and the care they receive. To do this, you need two key ingredients, one of which is learned skill and the second is a renewable resource: communication and empathy. Communication is the cornerstone of palliative care and a skill physicians can learn to improve patient experience. 1 Schools of today recognize that both communication and palliative care are imperative skills for physicians, and as such, we have imbedded it into the core curriculum of medical education. In addition, our hospital is building empathy and communication into the system through a clinical pathway called the Care and Communication Bundle to standardize care across all intensive care units using primary palliative care. 2 Studies show that giving a leaflet increases satisfaction and comprehension, and that having a family meeting can both improve communication and shorten length of stay, improving quality and decreasing costs3,4 We may never arrive at the North Star, but we are pointing our quality process improvement in that direction with a goal of achieving Triple Aim. I renew my empathy, I see my snowflakes, and I close the gap between delivering the care people want and the care they receive. I found the holy grail—and my cup runneth over.