Right now, many hospital systems put an inordinate amount of pressure on hospitals. Patients are staying for long periods of time because they have nowhere else to go, doctors are required to perform minor procedures that nurses are trained to perform and many governments don't want to admit that there are other options for those that can afford it. In Canada, approximately 7,500 people are living in hospitals (living is defined as having been there longer than 100 days) because they have nowhere else to go. That costs the system approximately $7.5m every day!!! Does that sound like an efficient system? We need a system where these people have a place to go where they get better care that is more cost effective. The hospital is the most expensive place they can be.

We need to develop local clinics and providers who can take much of this pressure off of hospitals. Hospitals should be a place where people go for emergencies and specific kinds of specialty care, not a catchall where patients stay because they have nowhere else to go. Develop local communities and homecare facilities to support those that need a place to go and be cared for, provide for better home care and give people options when it is time for them to be discharged from hospitals.

Like most businesses, much is lost in the transition from one system process to another. However, in most businesses this leads to lost money and profits. In healthcare, this leads to lost money and lost patients. There are lives at stake here so let's make a better effort to fix the problem.

Right now, patients are in the middle of a system where not much is integrated. Their records need to be shared by hospitals, specialists, local clinics, care centres and many other healthcare providers. But currently, patients are pretty much responsible for their own records, or least knowing about their health. Every time you see a specialist or a new doctor, you must go through the same discussion about past medical history and treatments. What happens if I am in a critical situation and am unable to tell anyone my previous history? Technology is advanced enough to have our medical records follow us wherever we go, so we need to create a system where incentives are given to make the patient experience seamless and more integrated. Start locally, then move to regionally and then internationally. Imagine a world where a universal health card stores all of my health records and information and it can be accessed virtually. The technology is there (think bank debit cards), so why not healthcare records? Because people are trying to tackle the system all at once instead of breaking into manageable chunks.

In the current healthcare system, there is not enough opportunity for healthcare providers (hospitals, group purchasing organizations, shared service organizations, etc.) to collaborate with their suppliers to make better decisions. There are four reasons for this:

1. Public scrutiny of healthcare dollars spent has forced many providers to be become more risk averse
2. Government purchasing legislation has forced purchasing departments to have much more influence in the buying process
3. Providers are short on knowledgable resources
4. Providers don't know all of the options available to them.

We need to encourage providers to make smart business decisions and leverage the expertise of their suppliers. Provide for a purchasing process that allows for a discussion between the provider and supplier in order to come up with the best possible solution and outcome. When this doesn't happen, I call it the Collaboration Gap, which is depicted in the visual below.

In our healthcare systems, we need to do a better job of creating processes that are proactive and engage patients and front line caregivers better to anticipate need. This doesn't mean patient and employee satisfaction surveys, although this is a good start. This means creating a process by which employee feedback can be gathered, analyzed and implemented. Create an employee feedback program and encourage staff to put forth ideas on how to improve the performance of the organization. Those ideas must be captured and reviewed, with the best ideas implemented. Success for a program like this will only happen if employees feel that their ideas will get a fair shake and that they see other ideas coming from employees being implemented. As for patients, employees need to be more aware of the ideas patients and their families may have. Talk to patients about their experience...what they liked, what they didn't like, whether or not they felt comfortable, if they had a positive experience that they would tell people about. All of these things can help gain a better understanding of what patients really need and some simple ideas to improve the performance and speed of the organization. If you treat patients like customers and recognize that they are a wealth of valuable information, then you are one step closer to improving your organizational effectiveness.