How Do We Fix the Medical Care Crisis?

This month, we anticipate the release of our book, Unbalanced: The Evolving Medical Crisis (Taylor, SM & Youkey JR.) written about America’s “Medical Care Crisis” as described by Montori and others.

Finished in May 2023, just before the release of the Harris Poll showing a 73% dissatisfaction rate with American medical care, the book examines the anecdotal difficulties patients experience when interacting with the medical care environment. While well-resourced and possessing the best doctors, hospitals, medical schools and industrial capabilities in the world, America’s medical care environment appears out of balance; no longer capable of placing patient well-being as its priority. The book is meant as a “wake-up call” for all of us. Awareness and change are necessary to rebalance the medical care environment.

Integral Leaders in Health is a public benefit corporation created to construct a process that restores patient well-being as our standard. In the articles posted on our website to date, we have vaguely alluded to solutions such as autonomy, communication, and adherence to moral duty. But we have not specifically proposed an effective, reproducible, and scalable plan to fix our current situation.

The purpose of this article is to introduce such a plan.

The plan is called Integral Leaders in Health MEDs (Medical Excellence Driven) Designation. Designation requires meeting standards that we believe will bring balance to the medical care environment. MEDs Designation aspires to achieve six chief objectives:

1. Brings general and academic awareness to the situation.

2. Mitigates clinical burnout of caregivers.

3. Overhauls communication.

4. Helps identify dedicated resources to fund the process.

5. Educates caregivers on how to deliver medical care.

6. Engages the medical industrial complex as partners, not vendors

The goal is to solve the Medical Care Crisis in that specific environment. For instance, the process might target a small town with a single hospital or a medical staff that is comprised of private and employed doctors or insurance carriers or governmental officials or community colleges that educate caregivers or business leaders or a defined population of patients. A Care Environment Self-Study Task Force (CESTF) is formed with representation from all stakeholder groups to include patients. That task force, then, oversees a prescribed process where five Standards:

• Community Integration

• Caregiver Integration

• Hospital Integration

• Payor Integration

• University/Innovation Integration

They are assessed using 40 Elements—approximately eight Elements per Standard. If all Standards and Elements are met, the result will be enhanced patient well-being and special recognition, the Integral Leaders in Health MEDs Designation.

Features of the process include community ownership of its medical care. For instance, the Community Integration Standard calls for the CESTF to transition after designation into a permanent community oversight council. That council would provide a community medical advisory service that helps patients navigate the medical environment. It will also regularly measure and monitor patient well-being in the community. The Caregiver Integration Standard contains Elements that promote doctor autonomy and address clinical burnout. The Hospital Integration Standard contains Elements that radically overhaul communication. The Payor Integration Standard contains Elements that ask payors to help identify resources to support patient well-being. The University/Innovator Integration Standard contains Elements that encourage teaching medical care (e.g., Availability, Affability & Ability) to caregivers and reengagement of industry as partners, not vendors. All in support of balanced medical care and patient well-being.

The process methodology itself is noteworthy. The Standards and Elements for MEDs Designation are patterned after the Liaison Committee for Medical Education (LCME) accreditation for medical school programs.

In the LCME process (and thus the MEDs Designation process), the assessment simply states that Standards and Elements must be addressed. It does not require a specific solution for each Element. For instance, the Element may say “The Medical Care Environment is comprised of autonomous caregivers (or groups of caregivers) acting with self-governance of their clinical affairs and in accordance with Moral Duty.” How a medical care environment chooses to comply with this Element is up to them. When such open-ended methodology is in place, innovative and original ideas always emerge. In this example, an employed, autonomous medical group model might be proposed as a means to satisfy this Element. There might be other new models that emerge as well. The point is, an open-ended approach like that used for LCME accreditation creates novelty that is translatable to other communities. This is different from accreditation processes where a certain way of doing things is prescribed and innovation rarely emerges.

Lastly, while the MEDs Designation is a new and original process (never been tried and shown to be effective in vivo), it contains Elements that have all been tried and shown to work elsewhere in healthcare (tested in vitro). MEDs Designation simply collates these proven processes and procedures into a comprehensive program directed at a specific cause such as making patient well-being the priority.

How do we fix the Medical Care Crisis? The answer, we believe, is Integral Leaders in Health MEDs Designation. We are currently looking for our first community to pilot the process—an opportunity, we see, to lead the direction of medicine to where patient well-being is the priority and all else is subordinate.