Salmon Upstream, LLC

Developing and implementing real-world community solutions.

There’s no place like home…

Last night, the dog woke me up in the middle of the night barking like Cujo and it scared the crap out of me.

Last night, the dog woke me up in the middle of the night barking like Cujo and it scared the crap out of me. It wasn’t the barking, or the fear of what was happening, it was that I could not figure out where the hell I was.

I am on a road trip. After an eleven hour drive and a fantastic meal at my uncle’s in Orange Beach, I was in bed early and out like a light. So when I sat up in the dark and there was faint light from where a faint light should be, and a dog barking from upstairs where our big dog would be, there was just enough familiarity to trick me into thinking I was home. Except our dog does all of his barking during the day, and everything else was just a little off, and I was alone, and I can’t find a damn light switch and WTF I cannot remember where I am and this is really, really scary.

Ironically, that’s what this trip is about. How we perceive our situation makes an enormous difference on our experience. Scary things are scarier in unfamiliar surroundings, and everything is easier wrapped in the safety and security of home. For patients who have to deal with the extreme challenges of fighting cancer, I want to be able to off-load as much of that stress as possible, and measure out a concentrated dose of warm, fuzziness.

Because he lives a long way from us and my family is none too keen on travelling, I don’t get to see my uncle often enough. Orange Beach is roughly halfway to my ultimate destination of Austin, Texas, so it made a perfect stopping point as I head to the Livestrong Foundation and the cancer center that they have created there. My goal is to convince them to collaborate with our community center and help us both figure out how to cooperate. I want to improve our patient’s care by bringing the highest quality treatments to the optimum environment: home.

As much as we like to tout its strengths, healthcare in the US is absolutely abysmal at collaboration. From small doctor’s offices to large hospital systems, we are trained to strive to be the best. But if I want to be the best, that means I have to be better than the other guy. And that environment is not conducive to extending a hand to anyone else, unless it is to convince the patient that what they really need is to come to me for treatment. You do want the best care, don’t you? Then you need to come here.

But wait, didn’t we just say that the ability to stay home – or as near to it as possible – is of enormous benefit? So to truly be the best, isn’t collaboration essential? Am I really the best if I am incapable of delivering care in the optimum setting?

The trick is to overcome the very real financial structure of our medical system that is perpetuating this otherwise surmountable problem. Because we get paid for treating patients, we are encouraged to draw them to us, and the promise of receiving the best care is the standard lure. Plus, delivering care is increasingly complex and margins grow ever tighter; we are all working harder for less. There is no time to waste on processes that are not billable. Like travel arrangements. Not my problem.

But what if being labeled a quality system required that you took the time to make things easier for patients? What if a top referral institution was expected to stay connected to the hometown providers, even after the patient returned home? What if we had an accreditation system that would only allow it’s stamp to be put on the billboard when the complete care for the patient was assured? Could that be a better lure for you as a patient?

If so, then this concept has value. Tangible, financial value. And like it or not, that is precisely how we can overcome these barriers. But I have to convince a cancer center striving to be the very best that being the very best means helping us be our best, too.

Because that’s the only way to really bring it home.