More than three decades ago, I read a book by an English doctor, who described his positive experiences during the cultural Revolution. Just today, I got around to the New York Times science section from last week in which nursing homes are starting to adopt slightly similar practices in which they distribute responsibility to all levels of caregivers. The basic difference, of course, is that in the Chinese case all the caregivers were given authority as well as responsibility, while something much different occurs in nursing homes.
What follows is my brief notation from the British doctor's book and some extracts from the article.
Horn, Joshua S. 1971. Away with All Pests: An English Surgeon in People's China, 1954-1969 (New York: Monthly Review Press).
Joshua Horn, a British doctor, depicted the changes that occurred in his hospital at the time. He described how nurses, orderlies, patients, and even patients' friends became active in the decision-making process. Although the typical orderly had no formal medical training, she or he would spend far more time with the patient than the doctor, who might have only a few minutes to spend with the patient. As a result, the orderly might have a great deal to offer in deciding what course of treatment to follow.
Schaffer, Amanda. 2008. "Fighting Bedsores With a Team Approach." New York Times (19 February).
"Experts estimate that two million Americans suffer from pressure ulcers each year, usually through some combination of immobility, poor nutrition, dehydration and incontinence. The Centers for Disease Control and Prevention does not keep statistics on fatalities, but one prominent victim was the actor Christopher Reeve, who died of a bedsore infection in 2004 in the middle of a heroic battle against paralysis. New research is suggesting that the battle against bedsores requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians."
"At the Lutheran Home in Fort Wayne, Ind., for instance, “the laundry workers helped us see that some clothes weren’t fitting the residents properly and were restricting their skin,” said Jeanie Langschied, a registered nurse there. The kitchen staff began putting protein powders in cookies to boost nutrition. They added buffet dining, so residents would not remain in one position for so long, compressing fragile skin. Even the beauty shop “realized that wait times needed to decrease,” Ms. Langschied said, and residents should be repositioned while getting their hair done. “It was all departments looking at everything, and it was just amazing the information that flowed through."
3 comments:
The trouble is, we rediscover the team approach and listening to ordinary workers every few years, and it sounds wonderful, and then it vanishes again. It's really difficult to work cooperatively within a hierarchy. In the end, power is always more important than getting the job done.
Maybe the Chinese were able to hold onto the team approach longer. But one of the reasons for the Cultural Revolution, if I am remembering correctly, was a fear that hierarchies were reemerging in China. And my understanding is, the Chinese health care system has pretty much broken down now, except for people with money.
This is not a statement of despair. The Cuban health care system seems to do very well. So, how do you create and maintain a good health care system?
When the Japanese auto industry was vanquishing the US giants, their team approach was discussed in every major news outlet in this country. I don't remember his name, but it was an American engineer that brought that system to Japan when he couldn't give it away in this country. The Japanese actually give a prize each year in his name, the winner being someone who has demonstrated a significant contribution to their manufacturing process. There hasn't been any further talk of this system since the discovery of real cheap labor all over the globe and the easy transfer of capital to those labor markets. I guess cheap labor trumps efficiency.
The man was Edward Deming.
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