- Leandro Herrero - https://leandroherrero.com -

The health-care-delivery Onion System does not need Big Consulting but small common sense. Maybe that’s the problem, it’s so uncommon.

My experience of several health care delivery systems, both as a patient and as external consultant, is that they function in onion mode. Translation. There are professional layers one on top of each other giving an appearance of single entity but operating almost independently.

For example, the nursing layer has a system; the doctors layer has another. The doctors have ‘doctors notes’ and the nurses ‘nurses notes’.  If you are ‘handed over’ to theatre (the anglosaxon term for operating room, and note the Fedex/DHL terminology) you discover another layer of the onion. Their internal tribes (anesthetists, theatre nurses, etc) operate in their own world within its own borders: those doors beyond which serious stuff happens.

The versions of what happens according to the different layers of the onion are also different. In my very recent and very short (hours) stay in hospital for a minor intervention, I encountered five different versions of what ‘will happen’ and all this in the space of 4 hours.

Every single tribe member (admin/receptionists, ward nurses, doctors, anesthetists and theatre nurses) gave me a completely different sense of timing, logic or expectations. All without exception were extremely kind. All without exception introduced themselves by name. The late Dr Kate Grange [1]who created the #hellomynameis campaign would be proud. I have no complain.

What the patient/user/consumer/person  (one has to be careful these days how to call oneself) sees as one system is not.

In the space of four hours, I was asked health-related questions five times, all more or less the same, all but one on written paper. In a couple of them, out of tediousness, I left blank several rather key questions with no answer, but nobody seemed to have noticed because I never saw back again the enquirer. It’s fair to say they were not read.

I was asked five times by five different tribe members about the last time I had eaten anything. Any information was obviously not recorded in a single place.

I don’t know whether you need a full multi-million Lean-Sigma-Agile-Whatever programme to realize the nonsense, the waste.

Not many years ago my young son was hospitalized for a couple of weeks. Same pattern. I remember a morning when a young doctor come to see me out of courtesy, perhaps knowing that I was a medical doctor myself by background: ‘Dr Herrero, we are waiting for yesterday’s blood results for your son’. ‘No, we are not, I said, they arrived in the evening and are in the notes, page 17’. Believe me, this was a very minor onion layer disconnect compared with others, all compounded by the fact that, due to my son’s age he was ‘under the care of the paediatricians’ but occupying a bed in a non pediatric one and taken care by other tribe. Did they talk? Not much.

Who is going to put an order on this?  Do we seriously need ‘case managers’ in the places they do not exist to see the whole of the individual?

Are we so comfortable in our own parallel universes that we don’t connect between ‘layers’ unless we have a crisis of some sort?

Onions! Perhaps if you peel them, you start to cry.