Perfecting The Brand of American Medicine

Introduction

America has the best physicians the world has ever known; Perfecting The Brand of American Medicine is about recognizing the need for sub-specialization in non-physician functions towards extending life expectancy. Not perfection nor brands nor medicine occur together on accident or by chance. These take human-centered design empathy harmony patience planning and proof.

Perfection presents increasingly through the maths of medical science and medical algorithms. Perfection can be costly with technology or it can be free such as caring. Perfection can compete with other priorities, other economic activities, but we should not leave anyone behind on this journey for curing illness, eradicating disease, and increasing life expectancy. We need your help in the search for truth on this dredging of a channel against the prevailing current of nature upstream towards a fountain of youth.

Anthropologically we have not been a perfecting medicine species; that is what we should become. Thomas Hobbes warned of life in anarchy “the life of man, solitary, poor, nasty, brutish, and short.” We need your help Perfecting The Brand of American Medicine today where life expectancy in America has waned for seven years punctuated by COVID-19. This after a historic run-up in life expectancy. The American dominance in global affairs, of the expansion of markets, of scientific progress, and the medical science ecosystem of extending life expectancy and improving quality of life rests upon you & me & us.

Brand quality (Chapter 3) does not commonly occur or persist; it has to be supervised. Humankind will need The Supervisor on Duty (Chapter 4) or a Chief Expectations Officer (Book I) as long as there is bedside care, as long as there are physical exams between the physician and the patient, and as long as we have entities dedicated to the centralized delivery of medical care (these hubs we now call hospitals & clinics).

We are not automobiles (Chapter 7). We are not cell phones (Chapter 12). We are not widgets. Humankind is more complicated than the things we have manufactured for ourselves up to this point. Americans will be Leading Expect to Local Perfection until we have dispelled from caregiving professions each and every myth from the mechanistic change management “religions” intended for making these inanimate objects.

Mostly I want to convince you there is a union of the medical care patients want and the medical care patients need at a sample size of one. One patient. One physician. We must confront the false promises of value-based care & the hypothetical constructs of the so called “virtuous cycle.”

On this journey American healthcare companies need brand inurement (Book III). AICPA has foretold the demise of accounting without describing what will replace it. There are no fewer than six of these fields (Chapter 10-15). These fields are best if bound to the tradition of medical science in America and Leading Expect.

Perfection must be measured wisely at the sample size of the individual. In the U.K. they use the word “maths” plural which provides multiple entry points for individuals into the field. In America we use math as a singular which has had the unfortunate effect of having some individuals in healthcare turn away from the science of their profession based on one disappointing math experience or one kind of math. There are others narrowly focused on algebra who neglecting the lifetime value of physicians or the lifetime value of patients. Perfecting the Brand of American Medicine is about mobilizing the maths that matter to every patient every time.

Perfection integrates quality and finance (Chapter 7). A fundamental flaw of this false dichotomy is that a quality human service may priced higher; the roster (Chapter 10) of the people, pride, and the quality of training are reasons the Ritz Carlton charges more than a motel.

Not all perfection arises from individual effort or individual accountability. Peer review (see Krebs Topology in Chapter 2) is the philosophy of competere (“getting fit together”). Peer review is valuable in and out of healthcare.

Not all perfections arise from competition (Chapter 1); there are spontaneous improvements for example inventions or medical licensure that improve life for all of us forever for the better. A fundamental flaw of competition is that it was not competition between medieval mystics that gave rise to medicine; it was a rebirth of wonder in the medical sciences and very specific licensing of physician quality coupled with rises in medical science.

Not all perfections arise from government (Chapter 3) where too much centralization by federal government can drain talent from a profession or from private practice. East Germany was a model of Socialism (prior to things like Olympic doping scandals) and to this day has lower life expectancy and lower economic output than West Germany; our rates of private practice approach East German rates from when the Berlin Wall went up.

Not all inventions arise from customer feedback (Patient Emotional Topology Chapter 5), but we listen to customer feedback to get it right the first time, it is our duty, and for this inclusive quest for Perfecting The Brand of American Medicine. A fundamental flaw of Lean and 6σ[1] is that the “voice of the customer” does not always yield the features patients want nor the features patients need.

Not all units of “value” are the same. A fundamental flaw of value-based care is there is a distance between our liberty for care we want and the actuarial care we need at the sample size of one. Great brands have to be envisioned, that vision has to be managed, and that management has to be supervised. The Supervisor on Duty or Chief Expectations Officer is clearly defined in every healthcare facility every day during every hour of operation. Even hospitals need a Supervisor on Duty. Even medical office buildings need a Supervisor on Duty. Even satellite clinics need a Supervisor on Duty.

Organization of this book

The first section of this book includes how The Supervisor on Duty is a Chief Expectations Officer for the facility of The Brand in mobilizing and decentralizing control of America’s healthcare system to the benefit of every patient every day every time. The Supervisor on Duty may vary facility to facility but is there to audit, to teach and learn from The Energy fields all around us, to function as a backstop for the Brand, and at best be a hero for the human emotions of the brand. Among other things Brands are a transfer of emotion from the heroes role models mentors within the brand to the patients sick tired or distressed outside the brand.

The second section of this book is for medical practice brands that are imperfect. Leading Expect is the human centered design predicated upon medical science (Chapter 6) that predates & will thus replace Lean & 6σ. It includes the Distress Recognition framework for identify variances & intervening timely. It is predicated upon the Patient Emotional Topology (Chapter 5) noticeably missing from Lean & 6σ.

There have been other tools such as 6σ; the challenge with 6σ is we are not machines, you are more remarkable than three in a million and science has sometimes performed better than 6σ in approximating orderly gyrations of the solar system or bridge crossings. In Chapter 7 we will talk about 6σ.

I have introduced Distress Recognition (Chapter 8) as the emotional topology to basic lifesaving that grew out of my lifeguarding experience. Distress Recognition is the commonsense skills for identifying signs for “when to call 911,” to rule enforcement such as “no running on the pool deck,” to identifying drowning signs. This ancient field has commenced in “vital signs.” Distress Recognition uses emotions words along an intensity as a heuristic for distress. Signs are different from symptoms, symptoms are self reported by the patient. Lifeguards know that symptoms are self-reported & that vital signs are objectively measured (pulse, breathing).

Distress Recognition omits clinically significant symptoms subject to algorithms but particularly nociceptive pain; pain is a self-reported symptom. Pain is a symptom & it is not a vital sign for the community population with the technology we have today. The Institute of Medicine & Joint Commission mandate for a 10 point Likert scale of pain as a diagnostic for the general population disastrously intervened in the opioid epidemic (Chapter 14).

The third section of this book is for introducing leaders to Brand Inurement; there are not college degrees nor advanced degrees in these important immutable fields of study. The Seven Topologies (Chapter 3) include reversable bridges between medical science, brands, operations, departments, revenue, assets, and net assets.

Bringing Perfection Home

My experience is that non-clinical professionals are happier the closer they are to the clinician and climbing a career ladder of opportunities and challenges. I invite all of you to become experts and professionals in your work irrelative of how distant you are from the physician.

I for example was once a secretary and a telephone operator. These terms were antiquated when I had them. What we once wrongly & pejoratively called “secretaries” may be orderly reorganized as professionals who may climb a career ladder (Chapter 10) and if they so chose could reach the top of their profession.

Every community, every physician, every practice is unique. The human design of medical science brands begins with medical science itself. The Chief Expectations Officer (Book I) is the patient-centered facility-level art, science, and maths for Leading Expect (Book II) in light of principles of Brand Inurement (Book III).

I am blessed to have been a basic scientist and I have worked in nursing and physician operations of the field of nearly every specialty of medicine. The leadership & supervision of your practice is relative to the medical specialty & the scope of practice. For the professionals not trained in medicine I offer a survey of topics at all levels of competency in the hope if they may explore lifelong meaning of an unfamiliar topic or survey for sections particularly relevant to them. Reviewers have noted this book is worth reading multiple times for mastery, as a reference, and as a learning tool for entry into medicine. Medicine is complicated. My intent for this series is to create a single song sheet across medical professions that could be read at the beach or listened to in a few hours. I encourage you to become a lifelong student of your work & to explore knowledge relevant to your work. Please do not be discouraged if a section proved too difficult the first time through; the crosswords puzzles were included for baseline mastery of terms.

We treat patients well – or they stop coming to The Brand. If they ever stop coming, we stop coming. If we stop caring about them, they stop caring about our brand irrelative of the quality of medical science. My intent with this book is to sell you on the idea that we have to redouble caring in Healthcare and change the world forever for the better. Anyone that wants to enjoin themselves with that journey is more than welcome.

Epidemiology Power Play is a Bigdata solution that has been missing for correctly matching physicians with the patient. It is the “Big How” for how the physician is marketed to the community’s demand. Every community is unique, every physician practice is unique and therefore, every Epidemiological calculation is unique.

There is distinction between a supervisor (Brand Roster Chapter 10) and The Supervisor on Duty (Chapter 4). The Supervisor on Duty is the Chief Expectations Officer of the facility with hour by hour accountability for that facility that day. The Supervisor on Duty is visible, auditing service, enabling Expectations so it is clear to the patient, the physician, and the clinician who is in charge at that facility. This is important to note because the Energy Potential of people, medicine, nursing, and sub-specialized physicians have not been divided evenly block by block & town by town & state by state across America.

[1] The Greek letter “sigma” has been adapted to a management philosophy