In trancurso of the twitterview Medical Journal, among other gems, I said the health sector requires a conversion ... What I mean by this?
Look at the diagram on the organization of a hospital ... that ye ... mind you.
In all cases we see a diagram that reminds us powerfully to a pyramid.
the past 60 years, these diagrams have been more or less branches of the same class.
Hospitals, therefore, are not designed with the patient in mind or with the clinician in mind ... are designed with the operator in mind.
decisions ranging from top to bottom (top-down ), with little or no opposition, there is little interaction side or diagonal, and facilities "of the force of gravity" of management in difficulties become decision if the road is from the bottom up.
And this within the same organization, because if we talk at the macro level, the fit is much more complex.
I have no doubt that when it undertakes a process re-engineering is done with process view, but not from an organizational perspective, so there is no genuine reengineering => no conversion.
And I think that being in the XXI century, in full immersion in what we call "knowledge society", continue with this model of organization ...
Believe me when I say that without vision the organization and clinical process re-engineering, ICTs increase the efficiency: they do is that inefficient to run faster ... Really
there is no alternative?
Because when building a new hospital, innovation is manifested in a technical or clinic, yet the organization and management model has not changed.
We filled the mouth of responsibility (empowerment) of patient and clinician, in " Equity and excellence: Liberating the NHS " talking to decentralize and empower management to physicians, but not the underlying structures change ...
We also talked about 2.0, but in most organizations, only the outside world.
I know the difficulties of those who, on a daily basis, spend part of their energy to overcome the inertia of organizations disorganized ... outdated administrative structures and oversized when, to paraphrase Johann Cruyff, " the money should be in the field ."
And some who, in desperation, abandon the struggle and, at times, the organization, because there has been a willingness to listen and understand. Let
get around this.
Assume for a moment that the "Pandora Health Service" has the crazy idea :-) (and financial resources) to create a different health organization, with levels of PA and Hospital Outpatient ... as different as the only constraint for its creation is not copy the usual pyramidal organizational model.
I asked a question on Twitter with this premise: the best response was "Well, then, would not be a hospital."
True ... the author of the response (Miguel Angel Máñez ) nailed it.
I have some questions ... "Easing the management overhead? "Management contracts? Process-oriented "? "Goals? "Multidisciplinary teams? Should there be a hospital property? "Stewardship? "Interaction between family physicians and specialties? How? When? How often? "Telemedicine? "Coworking?
How to combine this with criteria of relational networks, peer-to-peer ... and not die trying? Well ..
input and if we succeed, for me the winning combination would focused on patient and family doctor ... the family doctor is one who knows cross so the patient, who manages chronic if chronic and who should act as clinical consultant to the length and breadth of specialized levels of care ... and this implies that every clinical decision, of any kind whatsoever, should participate and be patient and jointly share responsibility for family doctor: the patient may be responsible, We can provide standard, but will always need support and professional advice that is closest to him ...
But thinking again, the support and co-responsibility model does not correspond to a binomial, a Combat Air Patrol approach ... the real model and the work would an equilateral triangle, where the patient would have a vertex in another family doctor, and the third to a representative of levels of hospitalization, citing the focus and center the process of care ... that's the model of responsibility that really work. What
care professional would the most suitable for providing accompaniment on the hospital level?
In my view, an internist because of all professionals in a hospital, is, along with pediatrician and geriatrician who can get a better look cross between specialties and who can best coordinate the work of everyone in a complex disease affecting various equipment ... and who, for having this vision, more like a professional practitioner.
The model will be shared responsibility with the family doctor in the transit of ambulatory care patient, shared with the general practitioner in hospital care, and coordination family doctor - internist to avoid gaps.
On the other hand, the orientation of the levels of hospitalization do not think it should be for services, the classical, but transverse liquid and targeting large groups process.
therefore required, imbuing coworking culture, since that provision involves a multidisciplinary organization with a professional relationship based on peer to peer ... the spirit of BreakOut.
In fact, I think the differentiation between primary and specialized care should no longer exist, so also would need to change the concept of care Hopitalaria and are turning to call Residential Care.
Streamlining of processes: it can be solved by ICT, which did not resolve a clinical ... no more administrative tasks. Therefore
horizontal organization between different levels of care, greater efficiency liquid and the administrative apparatus is reduced to a control of economic management.
The best way to test this model is to use the theory can of peas .
There was once an engineer who was asked to design a pea canning factory, the engineer had no one ever built ... so I asked him to teach how to make a can of peas: knowing the processes and problems in the manufacture of a unit, we can imagine / design processes for mass production.
And relatively speaking, is the way we used to approach this challenge successfully.
And you know what best part? This is not going to be in a post ... this was going to do.
It is possible to find difficulties, we should change approaches, and here the key is flexibility, dialogue, collaboration ... peer-to-peer ... coworking.
Be water, my friend. :-)
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