Dr. Gilstrap said the change in the way care is managed has resulted in very sick people being hospitalized, instead of their getting preventive care prior to getting that sick. When we compete that way, we, the health care providers, are not driving the care, money is. Dr. Hunter commented that the consumer drive is a very important part of that process. Dr. Hanneman stated that it should be patient driven, and to achieve that, we should start with a clean slate and figure out what patients need. Dr. Liehr suggested studying models of care that are patient centered.
Most employers only offer one choice of plan.
The lack of infrastructure for collaboration is appalling. The time for collaboration among nurses and doctors is not there, when nurses are overburdened by high patient to nurse ratios. It works well when it's done, but time pressures are reducing its use. Dr. Gilstrap described his mother's experience of being moved three times in one day to get the correct type of nursing care she needed. Dr. Hanneman commented that this is exactly what she meant by the care being organized according to the staff's wishes, not the patient's needs.