In football, each offensive play is preceded by a quick huddle. In the huddle the quarterback communicates the offensive plan to 10 other players who then go out and execute to the best of their abilities. If the quarterback is a good leader, and all players can execute the plan well, the potential exists for a successful outcome - perhaps a first down or even a touchdown.
Now imagine if there were no quarterback and no huddle. What if the best 11 players from the team simply went out and played to the best of their abilities. We’d probably see some hard hits once in a while, some pass completions, and a few good carries now and again. If good athletes were involved, the chances of seeing some “magic” here and there would be good…but not great.
Without a leader and a tactical plan in place, the “magic” would be few and far between compared with what could happen with proper planning and leadership. We’ve all seen underdogs that were given no chance of succeeding against larger, stronger, and faster teams (look no further than last night’s Oregon State upset over #1 USC for my inspiration for this post). And I’d argue that when this happens it is only through sound leadership, delicate coordination, and tactical execution that this happens.
The same is true in healthcare.
Our system needs strong quarterbacks. When we go out to tactically execute the diagnosis and treatment of illness or injury, often requiring a team approach, it requires someone to be in charge and communication to take place. A plan must be outlined and executed well if we are going to see the “magic” take place in our healthcare system.
Now, we kind of do have quarterbacks in healthcare, and who they are depend on the environment of care we are talking about. For most healthcare needs, the primary care physician calls the plays and coordinates the execution of the plan of care - our most popular quarterback. We also see quarterbacks in physical therapy ( the direct access model is catching on and continues to show much promise), dentistry, and a number of other autonomous healthcare disciplines. The problem in healthcare is that there is no consistent quarterback for each incidence of care, allowing us to often get too few or too many involved (not to mention that our execution often starts from the line of scrimmage rather than from the huddle).
Much of this is economy and policy driven, leaving our healthcare quarterbacks without the time to develop, communicate, and run the plays necessary to provide the best care. I’d argue that the 7-10 minutes that is often allocated to a patient would look something like a 3 second play clock between downs on the football field. How well would your favorite team execute under those circumstances?
The other part though, is that there lacks a cohesive infrastructure that allows our primary care physicians and other healthcare quarterbacks to effectively and efficiently communicate and transfer information and knowledge to the other parts of the team. The information systems, payment schemes, and overall operations within healthcare often allow us only to see the yard marker in front of us, not the endzone that we’re striving for.
The Florida Times-Union published an article today on the topic of healthcare coordination as relates to the priority of healthcare reform by our presidential candidates. It is a good look into the four areas necessary to effectively coordinate the care of our healthcare system, much the same as we will continue to see our college quarterbacks coordinate and execute plays on football fields across the country this fall.