Women Informal Family Caregivers

Posted on | June 4, 2008 | Comments Off on Women Informal Family Caregivers

The problem of “non-real work”

In the book “In Search of Excellence,” published in 1982, Tom Peters made the case that solving most business problems requires a critical look at processes, and an active, critical reshaping of those processes to allow for simplicity, ease of use, efficiency and reliability. One term he coined, which has stuck with me for 25 years, is the phrase “non-real work”. He was referring to all those chores that require time and assets but deliver nothing, and in so doing subtract rather than add benefit. A survey recently released by Gallup in conjunction with the American Academy of Family Physicians, focused on the challenges faced by women attempting to coordinate care for their families in our current health care system. It aptly describes the problem of “non-real work” in the flesh.

Here are some of the findings:

“Nearly 60 percent of respondents said they face challenges in obtaining health care for themselves and/or family members. And when they do receive care, they enter a system of confusing communications, duplicative paperwork and tests, and, at times, contradictory recommendations from different doctors. The survey found that when receiving healthcare for themselves and/or their family members:

43 percent of the respondents said they have had to fill out complete patient histories and other forms at each medical provider’s office.

26 percent said they have had to inform one medical provider what another had recommended or diagnosed.

16 percent have had to carry lab reports, x-rays and other test results from one medical provider’s office to another.

11 percent have received contradictory recommendations from different medical providers.

Nearly 10 percent have had to repeat lab tests unnecessarily because of lack of communication between medical providers.”

The AAFP and others have been advocating a Medical Home remodelling of health care. What would that entail?

“The medical home model employs a team-based approach to care that provides patients with:

preventive care, sick care and help managing chronic conditions;
expanded hours and same-day appointments;
care coordination across all settings – doctors’ offices, hospitals, nursing homes, consultants, and other components of the complex health care system;
electronic health records that serve as a “library” where the essential elements of a patient’s history and health care interactions are stored;
effective use of technology, making it possible for doctors to communicate with one another and stay up to date on mutual patients’ medical conditions;
virtual office visits via a secure e-mail system; and
the convenience of transmitting prescriptions electronically to pharmacies. “

Putting it all together, it is useful to incorporate process reengineering into new health reform modelling. As this latest survey correctly points out: women are playing primary roles in coordinating care logistics and care decisions, and their efforts are laden with non-real work imposed by broken processes which are both inefficient and non-productive. Moving the primary loop from “hospital – doctor’s office – hospital” to ” home – care team – home” is a critical needed step to reorient the center of care and to emphasize forward planning. But if we preserve our chronic disintegrated and non-coordinated processes, and continue to ignore informal family caregivers, leaving them socially isolated and non-integrated with the formal care team members, our gains will be eaten up in short order.