From a Horizontal Perspective

Sep 20, 2017 | Stakeholder Health Reflection, Stakeholder Health Stories | 0 comments


By Heather Wood Ion

For a week, I have had the privilege of watching how our healthcare system works, from ambulance ride to discharge, from a horizontal perspective. Most of our media reporting (from the vertical) comments on the financial and social crisis of American healthcare: it is absurdly, scandalously expensive, technologically driven, and unable to manage its multiple stakeholders. But a hospital exists to help with healing, not to satisfy abstractions of insurance utilization, regulatory reporting, or investors. The hospital where I have been serves a vast region of North San Diego County. It has 288 beds, 44 emergency exam rooms, and like hospitals in Minneapolis, Memphis, or Winston-Salem, an increasing, overwhelming demand for its services.

Never having ridden in an ambulance before, my expectations of melodrama and chaos were quickly calmed by my team of three paramedics: each proficient, cheerful, eager to tell me about their studies and dreams. How they got all those stickers for monitoring on various parts of my body I do not know, but they did each necessary thing well. When we arrived at the hospital, they dealt with the paperwork, the waiting and then the transfer to the gurney in the room where I would spend the next 26 hours with courtesy and unwavering vigilance. They came from three different countries, but shared a practical kindness which left me in awe.

The caravan, the choreography

From the gurney, I observed a constant caravan of sorrows, crises and palpable fear, but most striking was the choreography of the staff—moving always at speed, adapting as needed, and frequently saying to each other “thank you for your help”. The doctors, nurses, techs came from across the globe—Thailand, the Philippines, China, Mexico—but they worked as a disciplined ensemble, entirely focused on helping those of us dependent upon them.

There were moving moments: the young man with a mangled leg being wheeled to a room, but holding his son’s hand and saying: “We are in the right place, you will see, it will be all right.”. Or the dignified and elegant lady weeping quietly as she walked toward the exit. She paused a moment, shuddering and the young clerk at a computer stood and pulled the lady into her arms for a few moments of comfort. One was white, one was black, but did that matter? At night, the distress of babies and their families was a constant thrumming reminder that this enclosed world dealt with pain, and sometimes tragedy.

My doctors were candid, cautious and though clearly harried, always patient enough to reassure and to inform. I especially appreciated their willingness to say they did not know, but they would do their best to find out. Some of them were Navy trained physicians, and they spoke with great gratitude of the education they had received here in San Diego. Although I did not feel I was ill-enough to be there, they assured me that I was, and that they would give me all the help required to mend.

Transferring up to my room in Acute Medical, I encountered the astounding universe of nurses and aides, lab techs and housekeepers. They, too, came from a multitude of countries: the Czech Republic, Guyana, South Africa, India, Bangladesh, Indonesia. Some were funny, some were green and growing, some were very tired, but all of them were kind. This is where our healthcare system works—in the attentions and considerations of the care-givers by the bedside. Every day they save lives and restore spirits by the ways they show their willingness to help.

How the system works

Of course, it was not all positive. The expensive high-tech beds that constantly move to prevent bedsores were designed for automotive test dummies, not human bodies. The information systems and data gathering requirements were clearly self-serving, unable to support the constant adaptation of care-giving or of common sense patient care. It is obvious that hospitals need more staff, not for running insurance claims, but for paying attention to healing. Twelve-hour shifts turn into fourteen hours often, and one aide cannot attend to thirty sick people at once. Whatever cost-cutting and streamlining seems strategic, taking away staff should be the last alternative.

Now, I am at home, eating chicken soup made by neighbors, and most of the time, vertical. I am grateful indeed, to have seen that at the level of caring, competency, and kindness our healthcare system works. These invisible heroes do not shrug off their responsibilities because they are unsung and underpaid, they do not see differences, only need. When next you read of the healthcare crisis think of them—Olivia, Jasmine, Juan, Eric, Dana, Consuela and so many more—showing up each shift ready for the challenge of healing through kindness.

Stay tuned for Part 2!

You might also like this Interview with Heather Wood Ion


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  1. Incidental Findings - Stakeholder Health - […] See also: From a Horizontal Perspective, by Heather Wood Ion […]

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