Life is a tricky balance and is often about perspective. For example, when you go into the grocery store these days you now see all of these self check out options. It’s easy to see why stores like self check-out. They only have to have 1 person there covering multiple checkout stations. That’s a lower cost to them. While this is clear for the store and why they’ve made the change, the customer experience varies.
For example, many see self check out as the store forcing the customer to do the work. They feel like the store should do the checkout and pay for the people to provide that service. This makes some sense. At self check out, you’re basically working at the store as a checker for a few minutes. On the other end of the spectrum is people like me. I LOVE self check out. I hated sitting in lines waiting to be checked out (self check out has reduced lines) and I love being in control of the speed of how quickly I’m checked out. Maybe I have some control issues here, but self check out is so much faster for me and I love it.
The reality here is that neither perspective is wrong. And stores have to balance the reality of customers with different views and feelings about checkout. The same is true in so many parts of healthcare.
A great example of this was the reaction of nurses to a new Kaiser initiative called “Advanced care at home” that’s powered by a startup called Medically Home. It’s one of many remote patient monitoring companies in the space that are pushing care to the home. I won’t dive into the validity of the nurses arguments about this being bad for care or it being better. We’ll save those for another day. However, this situation illustrates perfectly how programs like this are in many ways asking the patient and technology to replace the nurse.
Ok, maybe it’s wrong of me to say replace the nurse. Nurses and their training can’t be replaced just like a checker is still there at the self check out stand to help if I have issues ringing up my groceries. In so many ways, it’s exactly the same comparison. Patients use monitoring tools at home which then allows one nurse to monitor many more patients than they would have been able to do in person at the hospital. It’s really not a replacement of the nurse, but it uses technology and patients to allow a nurse to care for a larger number of patients.
It’s not hard to see how a patient may look at this medical home and think, why are you putting me to work for you hospital? Didn’t I pay you to have you and your staff do your job caring for me? Sounds a lot like the person who doesn’t like self check out, no? Of course, on the other end, you have people like me who are happy to go home early and don’t want to spend another day in the hospital. I’m happy to work with the remote monitoring technology to track my condition, but I think it’s cool to have an active role in my care at home.
It’s a tricky balance here for sure. Plus, we could apply this to a lot of other areas. Is patient self scheduling a benefit to patients or is it a medical practice offloading their work to the patients? Should the patient be responsible for aggregating all their health history or should the healthcare organization do that for them? Ok, that may be a tricky example, but hopefully you get the point.
The reality is that many changes in healthcare can be seen through two different lenses and we can often choose which lens we want to look through. One patient may see access to their health data as empowering and wonderful. Another patient may see it as the patient trying to offload responsibility for that data to the patient.
Finding the right balance here is hard. Going back to our self check out analogy at the grocery store, they’ve found the balance by having some checkers still there to check people out along with the self check out. That way I can use self check out and others can have someone check them out. Plus, when I have a full cart and 4 kids I sometimes like someone to check me out too. The same is true with healthcare. We need to provide flexible options that provide for those that want a more active role in their care, but also think about those that don’t or can’t play that role. Getting that balance right is harder than it looks.
