By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Healthcare in the United States is almost 20% of GDP, with spending approaching nearly 5 trillion annually. Unsurprisingly, many business communities see healthcare as ripe for disruption and innovation. They would be right about this but are also learning some tough lessons as they try to innovate. Those in healthcare know and understand that while massive change is needed – it is also tough to disrupt this industry. Healthcare is messy and complex. The product is professional human services delivered to human beings.
I was not surprised to see Amazon shut down Amazon Cares last week. It came on the heels of some unflattering interviews with former Amazon healthcare providers. The stories they told were of a company obsessed with the customer experience – you could track your healthcare provider coming to your house like your Uber driver. They were less obsessed with what happened when the healthcare provider tried to deliver care when unexpected problems arose or where labs should ideally be stored before processing. It turns out that having physical space matters as you try to scale services. There is a level of professional liability that does not exist in other industries, and Amazon has deep pockets.
Financial analysts looked at what happened and surmised that Amazon was learning some hard lessons. To Amazon’s credit – they innovated and failed fast. They may be able to translate some of what they learned if they solidify the deal to acquire One Medical. Unlike what they designed with Amazon Cares, One Medical has physical offices in many major cities in the US.
When I read about Amazon’s experience, I was reminded that I had been involved with plans to disrupt how healthcare was delivered in the Department of Veterans Affairs. In the early 1990s, I was part of executive leadership that planned the building, staffing, and operations of the VA Medical Center in West Palm Beach, Florida. At the time, it was the first new VA Medical Center that was built in 20 years. We had unique opportunities to redesign care differently, and one of the most innovative executives I have ever worked for was at the project’s helm. He reminded us often that the canvas was essentially blank. We were determined to do things very differently, and to a certain extent, we did.
The hospital opened in 1995 with an electronic health record – the first in the VA to try this from day one. While today, this innovation may seem minor – back then, it was a significant shift in how patient records would be managed. At the time, the EHR was used in only a small number of settings nationwide, even outside the VA. Few clinicians had home computers, and many could not use a keyboard. The upskilling of the workforce to handle this one disruption, along with so many others, proved very challenging. Primary care visits that should have taken 30 minutes morphed into one hour as providers struggled with data entry.
We thought about many things in the planning but frequently underestimated human nature. The processes which looked great on paper often did not work out as planned when you added clinicians and patients to the equation. Many nurse leaders now confront this every day as they work to change their care delivery models and accommodate the endless scheduling flexibility that nurses now want in their lives.
Changing healthcare is hard – because the essence of healthcare delivery is an intensely human experience and humans are not predictable. There is often little evidence that something will work when you are on the bleeding edge of a change, so you iterate and try things. Some things we plan won’t or don’t work. That is what Amazon has learned from its early ventures into healthcare with both Amazon Cares and Haven. Healthcare is hard to disrupt, no matter how much change is needed.
© emergingrnleader.com 2022
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