HJAR Jan/Feb 2023

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2023 13 it to a new primary care physician. She has been told that this clinic is different, but she is ap- prehensive and does not understand why the appointment would last an hour. She is nervous and fearful of being judged or even reprimand- ed. She is an uncontrolled diabetic with class 3 obesity who is not taking most of her medica- tions, is not exercising, and knows there is con- siderable room for improvement in her diet. The patient is roomed by a smiling care coordi- nator who is passionate about her job because not only is she highly regarded as an important member of the team, but she truly feels like she makes a positive impact in the lives of the pa- tients she serves. It’s why she went to school to become a medical assistant. This care coordi- nator obtains the usual biometric markers such as weight, height, blood pressure, and pulse, but also has the patient complete screen- ing questionnaires that delve more deeply into social determinants and mental health. The physician enters the room in an unhur- ried manner and meticulously begins to gather the usual historical inputs, like past medical and surgical history, medications, and aller- gies. In time it becomes clear to the patient why the appointment is scheduled for an hour. Her new physician is asking lots of questions, attempting to build a deep and comprehen- sive understanding of her cumulative set of life experiences. In a kind, gentle, nonjudgmental manner, the physician not only wants to fully understand her current set of health behaviors, but also wants to understand the “how” and “why” behind them. At one point during the visit, with shame in her eyes, the patient admits to a habit of going to a local bakery at least once a week to buy a dozen doughnuts on her way home from work. During particularly stress- ful weeks, she may go twice. To her surprise, the physician does not frown or even convey a look of disapproval. Instead, the physician em- pathetically asks, “Why do you do that?” The physician has already discovered that some of the patient’s fondest memories from child- hood were spent baking with her mother. But her mother died a few years ago after spending several months in hospice. During that time in hospice, her mother’s appetite diminished to the point where she would only eat one thing ... doughnuts. The patient shares that she has experienced multiple miscarriages and had entered a state of hopelessness and despair, leading to severe anxiety and depression. After performing a comprehensive physical exam, the physician asks the patient about her health-related goals to discover what matters most to her. The patient wants to conceive a child and have a healthy baby but knows that with her uncontrolled diabetes, such a goal seems impossible. The physician documents other goals in the medical record, such as wanting to eat healthier, lose weight, and to start exercising. The physician only has one goal — to earn the patient’s trust, realizing that the only way progress will be made is by forging a collaborative, trusting relationship with the patient. The physician leads a multi- disciplinary care team that places the patient, their goals, values, needs, and preferences at the center of everything they do. Together, with the patient and the rest of the care team, a shared action plan is created. The plan iden- tifies the barriers, obstacles, and challenges standing in the way of the patient’s goals and proactively addresses them. With the help of the team’s behavioral therapist, dietitian, and health coach, the patient loses 30 pounds over the next six months, stops eating dough- nuts, experiences dramatic improvement in her depression and anxiety, achieves excel- lent diabetes control, and becomes pregnant. Now consider that the story above is true ... and is only one of many more just like it. The future reality is when this type of care becomes the norm for everyone. Being a member of the healthcare profes- sion is both a privilege and an honor. We are in a position of being able to heal, to provide care and comfort, and to touch the hearts and minds of those we are fortunate enough to serve. Any one of them may be the parent of a future inventor or agent of discovery. Or any one of them may be a future impactful leader who, over time, will help countless other people. Regardless of their individual potential for positive impact on the world, all of them have lives of intrinsic value and worth, with people who love them, who want to see them receive the best care possible and achieve their optimal state of health. So, let us envi- sion a world where those of us in healthcare are completely aligned around a mission to care for those in need and improve their health ... while holding ourselves accountable for the outcomes. Let us also create a world where caregivers come to work and connect every day with the deep sense of purpose of why they entered the profession, while also strongly recommending it to generations to come. THE MISSION Changing the world is a big, bold audacious mission. Some might even call it a “moon shot” based on the declaration issued by President John F. Kennedy in 1962, when he declared, “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard.” Considering that less than 60 years earlier we had not yet even solved the mystery of flight, let alone suc- cessfully launched a mission into space, it may have seemed impossible. Despite the enor- mous complexity and plethora of obstacles to overcome, a course was charted toward mak- ing the dream become reality. Over the next seven years, mistakes were made, and lives were lost in service of that mission. But for ev- ery mistake, lessons were learned, new knowl- edge was created, new solutions to problems were implemented, and progress was made. The mission was facilitated by a culture at NASA that resonated in the souls of every person who worked there. The story goes that during a visit to the NASA Space Cen- ter in 1962, President Kennedy noticed a janitor carrying a broom. He interrupted his tour, walked over to the man and said, “Hi, I’m Jack Kennedy. What are you doing?” “Well, Mr. President,” the janitor respond- ed, “I’m helping put a man on the moon.” There are some people in healthcare who would look at the patient’s story above and say that it all sounds great, but it is just not pos- sible to scale the approach broadly. I would challenge that view by asserting that scalabil- ity is a function of replicability and profitable growth. Replicability becomes a function of understanding all the relevant input and out- put variables that influence an outcome, fol- lowed by meticulously measuring those vari- ables and outcomes. Profitable growth is a function of the business model — how value is created and captured — and business mod- els can be changed. Through business model reinvention and care model redesign, along with iterative and recursive cycles of learning and continuous improvement, anything is pos- sible. I am quite certain there were skeptics who doubted that we would ever make it to the moon and back. Fortunately, those voices did not dominate the culture of NASA, nor do