“A priest, a doctor and an engineer were waiting one morning for a particularly slow group of golfers. The engineer fumed, "What's with those guys? We must have been waiting for fifteen minutes!"
The doctor chimed in, "I don't know, but I've never seen such inept golf!"
The priest said, "Here comes the green-keeper. Let's have a word with him."
He said, "Hello George, what's wrong with that group ahead of us? They're rather slow, aren't they?"
The green-keeper replied, "Oh, yes. That's a group of blind firemen. They lost their sight saving our clubhouse from a fire last year, so we always let them play for free anytime."
The group fell silent for a moment.
The priest said, "That's so sad. I think I will say a special prayer for them tonight."
The doctor said, "Good idea. I'm going to contact my ophthalmologist colleague and see if there's anything he can do for them."
The engineer said, "Why can't they play at night?"
This joke was referenced in a New Yorker article titled The Engineer’s Lament by Malcolm Gladwell regarding safety/defect/risk calculations and recall decisions regarding the Ford Pinto’s gas tank, Toyota’s sudden acceleration and others.
The article emphasizes that compassion needs to part of the formula and, while machines and the men and women that make them are getting better and better at assessing probabilities and helping us moving us closer to zero defects, they cannot adequately adjust for or quantifiably measure increases or decreases in compassion. Decisions based primarily on “big data” and zero defects without accounting for compassion can often lead to disastrous results; despite what is deemed logical and supported by evidence by the experts.
I think similarly the most critical component of population health is identifying and compassionately managing the health of the small percentage of those among us who we can’t cure – those among us with chronic conditions. Evidence based protocols wired into clinically integrated networks is not enough. Assistance and empathy is needed for them, for their families, their advocates and their care teams to make informed decisions along these life journeys that, many times, lead to palliative care. In these cases - especially in these cases - the word “discharge” might never enter the conversation. These folks may be on journeys that end in hospice. Yes, there are costs to be avoided and saved along the way but the opportunities to exponentially increase the levels of compassion (individually and collectively) in population health management are critical --- and perhaps at the root to successful transformation from fee for service to value based care.
I am reminded of a professional assignment many years ago when EMRs were in the early years. I interviewed a health system CEO near the end of his career who had recently made the decision to go “all in” with Cerner system-wide, rather than a slower toe-in-the-water strategy as other systems were doing at the time. The total cost was $125,000,000 (a low number considering the cost today), most of which was allocated to the training of staff. I asked why the system made that decision and he replied, “So our nurses will have more time to pray with their patients.” … I am not sure he got what he bargained for.
By: Scott Keller, President and CEO