Houston, We Have a (Systems) Problem

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Stephen Hawking's recent death has sparked conversations among healthcare workers around the world regarding healthcare systems. Dr. Hawking commented in a presentation just over six months ago that he did not believe he would have lived so long if it wasn't for the National Health Service in the U.K. He felt the healthcare system in his country was directly responsible for extending his life past the anticipated expectancy for someone with Amyotrophic Lateral Sclerosis.

Upon reading the online comments left by readers of some of the articles regarding Dr. Hawking and his life, I was disheartened to see how many individuals suggested he wouldn't have lived as long had he been within the U.S. healthcare system. And, sadly, they could be right. In a study performed in 2013, the U.S. ranked last in healthcare in a comparison of 11 other high-income countries. In that particular study, the U.S. ranked last in access, equity and healthcare outcomes, and next to last in administrative efficiency. The World Health Organization (WHO) lists the U.S. as 37th out of 191 countries with healthcare–just above Slovenia and Cuba. Last week, the U.S. News and World Report shared how the numbers of low birthweight babies are increasing as a result of the healthcare access and equity issues in our country. Our healthcare system, to be blunt, is broken.

Organized healthcare systems were created barely over a century ago, primarily due to the demand of needing to keep employees healthy for work or soldiers ready to fight in wars. According to the WHO, the focus of healthcare systems is to promote, restore or maintain health. Individual countries determine how exactly that happens based on the needs of their citizens. Additionally, the WHO believes healthcare systems have a responsibility to protect people against the financial cost of illness. In the U.S., finances have been at the crux of our issues, and the difference in political beliefs regarding how healthcare should be funded are partly to blame for the lack of any recent major reform.

Last summer, I had the opportunity to spend the month of July in Nottingham, England, with nine of our nursing students for our study abroad Community Health nursing course. The students spent three days of each week with nurses in Nottingham, seeing patients in a variety of settings. Every night we would gather around the dining room table to talk about our days, and, inevitably, the conversations would drift towards comparing the healthcare systems in England and the U.S. The differences between our two countries' systems were painfully obvious to the students.

It can be difficult for the nursing students to understand how the U.S. is so low in the healthcare rankings. They see excellent care provided by the healthcare workers in their clinical settings. Additionally, they know the educational preparation for nurses in other countries is typically less than what it is in ours. But students in the clinical setting are usually more focused on providing direct patient care and not on examining the healthcare system. That, however, is changing.

In the nursing curriculum, we've been working towards helping students learn about the healthcare system in the U.S. and other countries and how to become a systems thinker. This approach helps students see how different parts of the healthcare system are interrelated and to recognize that there are often multiple interventions to a problem. Students in one junior-level course are asked to explore different pieces of the healthcare puzzle each week while in their clinicals, then come back to class and share what they've discovered. Sometimes students in a clinical setting step back from direct patient care and observe what is happening around them. At other times, they follow a patient's journey in the healthcare system to gain a better understanding of their perspective. And, finally, they also may do direct patient care with the question in their minds of "How is the system impacting the care I'm providing and the health of my patients?" Students have shared how they have productive dialogues with healthcare workers during clinicals regarding various system issues. They are asking more questions about it in the clinical setting and sharing information they've learned with nurses in their clinicals. One student asked how she can become more politically active, specifically for the benefit of the healthcare system. Another one requested more information about the issues within the healthcare system to share with a friend after watching a video for class. They want to learn more and be a part of the change.

Yes, the healthcare system is broken. But I'm optimistic! Our students want to provide the best care possible for all people and have genuine concerns about the future of healthcare in the U.S. They understand that improving the healthcare system does not mean we must emulate any one country's healthcare system, but it may be that we can learn from other countries that rank better than the U.S. at keeping their citizens healthy. With a good understanding of what is happening in the entire health system, it is possible for our students, in the future, to develop strategies to influence the overall aims of health policy in the U.S. This does not necessarily have to happen at the federal level for changes to occur. They may be transforming care in their own direct work areas, which can have a tremendous ripple effect across the entire system. Luther College nursing graduates have always been leaders in practice. The next generation of nurses from Luther College will also be purposeful healthcare reformers!

La Donna McGohan

La Donna McGohan

La Donna McGohan, Luther College associate professor of nursing, is the head of the nursing department as well as a '95 graduate of the school. She completed her master's degrees in Nursing Education and Nursing Administration at Winona State University, and her Doctorate of Nursing Practice at Minnesota State University, Mankato. LaDonna's nursing interests are primarily in how religions influence the health care practices of their members.

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