Because the hospital is seen by the physicians, nurses, patients and families as “the best place to get the best care” it paradoxically can lead to an over-dependance on hospitalization as a solution to complex challenges outside of the hospital. It is much harder to garner resources needed to care for complex patients outside of the hospital—the core challenge impacting both length-of-stay (safer to stay until you are strong enough to handle lower resourced care outside of the hospital) and re-admission rates (it is Friday and we can’t get the labs and imaging done quickly enough out here in clinic or in your home, so you need to go back to the hospital to get those things done ASAP).
Resource concentration within hospitals may actually be a primary source of an inability to impact both length-of-stay and re-admission rates. That’s likely why most hospitals have longer lengths-of-stay than they believe they are capable of and 75% of hospitals in the United States (or more) get fined by Medicare every year for excessive re-admission rates. Paradoxically, hospitals may need to share their resources in order to reduce length-of-stay and re-admission rates with out-of-hospital care teams and organizations that can help them address this complex polarity.
Managing Polarities: Case Study II [Hurd Immunity AND NPI/Social Distancing]
Many of those involved in the deliberation regarding a pandemic policy initially framed the policy as an either/or option. Those offering the herd option are taking the follow stand: “. . . the fact remains that herd immunity isn’t merely a possible strategy. In the long run it is the only strategy. The question, then, is how to get there responsibly.” The proponents of nonpharmaceutical interventions (NPI and social distancing offer an even more absolutist stance: “the withdrawal of a social distance policy is unethical and immoral. It is counter to everything we hold precious as human beings.”
We will frame our analysis around these two polar-opposite stances and begin by identifying some of the benefits and disadvantages associated with each policy. The benefits in both cases yield short-term (tactical) and long-term (strategic) outcomes. The disadvantages we offer relate to what we don’t know and what might be an unexpected and devastating outcome.
