Improving community health with more people and less cost

I’ve been wrestling with the uncomfortable realization that most of the innovation efforts in healthcare really just incremental improvements. Sure, we’re making wait times in the ED shorter, and we’ve made the imaging centers look like fancy hotels. We’re also making seriously and important strides at reducing harm and improving quality.

But these are all just incremental improvements. They are iterations on the same thing. A new way to register, round or operate on someone are still the same basic things we’ve been doing forever.

To be fair, that may be perfectly ok. And, it is certainly noble to improve quality, reduce harm and make experiences more humanistic.

Hold that thought in your minds along with this: In ever design session I’ve been a part of for the past two years, providers and patients alike all want one thing — more people.

We are dying for more human contact in healthcare. We call them navigators, ambassadors, concierges. We want them to help us get appointments. We need them to help advocate for us when we cannot advocate for ourselves. We want them to be our scribes because…well, because EMRs. We want more people so we can have more time to spend with patients. And we’ve gotten to the point where we hire them to help us decipher our healthcare bills.  

I’ve been trying to reconcile how we might have our cake and eat it too. How can we have more people and simultaneously less cost? Or —and here’s where some patented thought technologies come in to play —what else could we do with all the expensive people we already have? 

You see, while we’re busy craving more bodies, we’re also getting much better at moving things out of hospitals which are notoriously expensive, dangerous and hard to operate. Inpatient stays are down. Surgeries require less and less time in the hospital. We’ve moved a lot of things to outpatient settings. So what do we do with all the people we’re committed to employing?

It seems some wisdom from a trip to Africa inspired the folks at City Health on exactly how to crack this nut. I really like the idea of community health workers. Now add on the idea of using our existing healthcare workforce as community health workers. Wooohhaaa!

But Wait, you’re shouting. Where are you going to get these people, Nick? We’re staffed so lean already. Right, but are we using our people wisely? By being ready to redeploy hospital employees, especially when we know utilization is going to continue to decrease, feels like smart planning to me. Plus, hospitals are already set up to take in payments from payors and redistribute it in the form of income to employees.

Here’s the deets from NPR:

Thats how the idea for City Health Works was born. Kaurs husband, Dr. Prabhjot Singh, partnered with Kaur to get the project off the ground. The pair raised about a million dollars from three sources: The Robert Wood Johnson Foundation also a supporter of NPR, the Robin Hood Foundation, and Mt. Sinai Hospital, where Singh works.“


We really need an ambassador, somebody that really understands the clinical environment, but is deeply embedded in the community- Prabhjot SinghSingh says a lot of the people he sees in his clinic at Mt. Sinai are in really bad shape. “People youd expect to see in the hospital. People you couldnt imagine are in such a late stage of illness,” he says.


Its this population City Health Works really wants to help. The idea is to get patients to the clinic before they get so sick, and then help them stay out of the clinics going forward.”We really need an ambassador,” he says. “Somebody that really understands the clinical environment, but is deeply embedded in the community.”

via An African Village Inspires A Health Care Experiment In New York : Shots – Health News : NPR.

  • P Clarke Thomas

    I spoke with a friend in med school a few days ago, it was disturbing how much he drove home the idea of no bedside manor. That you want someone who’s focused on issue & not the patient. As if all patients are lab rats.

    Gathering from that & knowing people in all sections of hospital work. I can see a need for personal disconnect for two groups. Surgeons & ER/Triage nurses/doctors, these people need to focus on the issue at present & resolve it, regardless of who the patient is. It’s the doctors & nurses which rare to never enter surgery where hospitality needs growth. It may not be about adding more people as much as retraining.

    • Nick

      Clarke – I think you are on to something. There’s a need for a different kind of care at different times. Trauma isn’t the same as cutting your finger making dinner.

  • Leigh Anne Cappello

    Great point Clarke on the differing roles within the healthcare setting, and I would add that patient training to help them understand the power of their own narrative in their care is needed.

    And Nick, loving your point on the need for more transformational, systems-level changes in healthcare, vs the tweaks we so comfortably gravitate towards. Because system level change is scary and hard, but critically needed. It’s what we think about everyday here in the Patient Experience Lab at the Business Innovation Factory. We should connect and share stories!

    • Nick

      Sounds like your group is doing the right kind of work Leigh Anne – kudos!