Small Changes Strive for Big Results for the U.S. End-of-Life Care System

The problem with the U.S. end-of-life care system is it doesn’t seem to actually take into consideration the individual who is dying. This is the disturbing takeaway from the new “Dying in America” report, conducted by the Institute of Medicine.

Dr. Diane E. Meier spelled out the issues regarding the U.S. end-of-life (let’s call it EOL) care system very clearly on NPR’s The Takeaway on Sept. 18. The report details how the American healthcare system treats EOL (and my use of the word “treat” is not accidental) and all its challenges – medical, financial, moral and familial. The conclusion: not well.

Our entire system is procedure-based, not palliative-based, meaning that we are subjecting patients – and their families – to extraordinary measures that they may not want. These measures do not deliver quality of life even if they extend quantity of years. They also aren’t responsive to what patients and families actually experience at the end.

At the center of this important, under-addressed issue is dissymmetry. Dissymmetry signifies that some, but not all, elements of symmetry are missing. That’s what we have here with our EOL system: dissymmetry caused by the absence of the individual in need. It’s easy to list the building blocks that make up this dissymmetry: resources, incentive structures, access, information, support and mandates to drive new behaviors.

So now we have a diagnosis: Our EOL care system is dissymmetric to the needs of the population it serves. After a diagnosis, we typically look for a remedy.

Instinct and reflex tell us that a problem this immense demands a solution just as big. We have to rethink, reimagine, overhaul, re-engineer (insert your business transformation buzzword here). And we tend to address complexity with more complexity.

But does this have to be the case? Does every major problem really need a complex answer, or can we make more happen through small, targeted, almost atomic interventions?

There’s precedent for small actions, and data to demonstrate how they work. In the UK the “tuck in” program provides a companion to elderly patients who wish to remain at home but require assistance. The employee associated with the tuck-in service visits the patient’s home every morning – helps the patient get up, dressed and bathed. The tuck-in caregiver will also set out the patient’s medications for the day and cook meals before leaving in the afternoon to return the next day.

We could institute a similar program in the United States tomorrow. And while U.S. health policy experts know that, what most people don’t know is that throughout the nearly 1,000 pages of the Affordable Care Act (ACA) are hundred of ideas, many small and targeted, to be tried and tested.

One example is Maryland drawing from the ACA to educate citizens of Cumberland, Md., where the obesity rate is 29 percent, about the basics of food choices and the importance of exercise. Both the UK example and U.S. examples are different ideas, aimed to solve varying problems, but here’s what they share: They do on a human scale what EOL care systems don’t because these programs are person centered, direct and actionable.

This kind of thinking isn’t reserved for health policy experts. It’s our job too, as healthcare marketing practitioners, to find more human-centered solutions.

Let’s use the skills we’ve developed to identify well-calibrated ideas to solve specific problems. Let’s leverage our perspectives to create ideas that aren’t over-engineered and have a real chance of success. Let’s think in new, tight, focused ways to see if we can help drive real change. Let’s look for the elements to lessen the dissymmetry between the people in need and the systems and resources meant to address those needs. Finally, let’s put everything in its right place (thank you, Radiohead).

Small Changes Strive for Big Results for the U.S. End-of-Life Care System