A Perfect Post-Pandemic Health System
During the pandemic, we ignited a race to develop COVID-19 vaccines. Now at the tail end of it, we have a new race – to redesign a healthcare system that perfectly captures the ethos of a post-pandemic world.
First we had clinical researchers working at a breakneck pace to develop vaccines. Now we have public health leaders jockeying for C-suite roles at healthcare systems. They are racing to parlay policy for position, seeking the most glamorous corporate jobs available relative to their role in public health policy. Healthcare systems cannot scoop them up fast enough, as though that one individual is all that is needed to create an ideal model of post-pandemic patient care.
In Illinois, the state’s director of public health is wooing healthcare systems for the role of CEO. And she is not alone. Many who previously worked in public health, whose star rose during the pandemic, are now capitalizing on newfound social capital to leverage pandemic glory into prominent roles in corporate healthcare.
It makes for a curious, Faustian bargain, equating public good with private enterprise, and creates strange bedfellows in the most unlikely of places. Such as medicine and marketing, which have long had an odd relationship. Both need each other, but each denies the need for the other. Yet the need for marketing defines success in medicine. Just look at the prestige Cleveland Clinic and Mayo Health enjoy. Whether clinically justified or not, these institutions carry weight in the minds of patients largely on the basis of name recognition. This is marketing.
It defines how we perceive medicine and our individual health. And in turn, it defines how healthcare systems perceive patients. It is no coincidence that name-brand hospitals charge more for clinical care than those that lack such marketing prowess.
But medicine by marketing bodes poorly for patient outcomes – and equally poorly for healthcare at large. When a hospital promotes itself, we call it marketing. When an individual promotes himself or herself, we call it influence. Though we use two different words, the premise is the same – influencing others through brand appeal. A power many physicians and policy makers recently acquired during the pandemic and wielded with deft precision.
Over the last two years, we listened to the most influential voices and silenced all others. These voices quickly garnered followings, and soon the masses were divided into camps based on specific allegiances to individuals. This led to a rise in pandemic policies based on the perspectives of a select few. We then determined which health policy positions to adhere to by following the most influential voices.
It allowed these individuals to implement public policy by political strategy. Those who established the most gravitas appeared the most credible, and subsequently the most influential. They posted on social media. They appeared frequently on mainstream media outlets. They wrote articles and opinion pieces. And they established credibility without any scientific rigor. Simply the repeated appearances proved all that was necessary.
Under most circumstances, this would appear ridiculous. In healthcare, it appears to be part of an ongoing trend. One in which the individual rises above the institution, where the weight of individual statements takes precedence over institutional methods of public health research.
This creates a problem for healthcare, which is uniquely institutional. No matter how good the leader, it takes a system to implement patient care. Healthcare thrives on peer-review, consensus, and the many checks and balances in which clinicians and policy makers of different backgrounds deliberate over the optimal course of clinical action.
But increasingly, healthcare systems are gravitating towards individuals to lead them, believing their pandemic experience can translate into expertise in healthcare leadership. This may make for good short term marketing, but long term it empowers these individuals to continue bucking institutional traditions.
If healthcare becomes dependent on individual leaders to guide it, serving as the sole voice of science and health, then the institutions of healthcare will inevitably succumb to the whims of the individual. But what else would you expect in a world where an individual carries more decision-making power than an institution?
This is nothing to aspire for. But it seems to be what we are racing towards, all in our quest to build a perfect, post-pandemic model of healthcare.
Antibiotic Prescriptions Associated With COVID-19 Outpatient Visits Among Medicare Beneficiaries, April 2020 to April 2021
Outpatient Visits for COVID-19 and Associated Antibiotic Prescriptions Among Medicare Beneficiaries Aged 65 Years or Older, by Setting, US, April 2020 to April 2021. The volume of COVID-19 visits differed by setting: emergency department, 525 608 (45.8% of all visits); office, 295 983 (25.3%); telehealth, 260 261 (22.3%); and urgent care, 77 268 (6.6%).
Source: Journal of American Medical Association Network