Something occurred to me while I had my head stuck in the dryer.
I guess that bears some explaining. You see, our 11-year-old dryer, like a few other “things” that turn 11-years-old in our house has become quite loud and obnoxious. Like our other 11-year-old “things,” it has taken to only working on its own schedule; it can’t seem to be bothered with the schedule of its partner, ol’ Washy, sitting right next to it. It’s sort of like another 11-year-old who sometimes couldn’t be bothered with homework as long as there were fish to be caught in the pond in the backyard. But our dryer, even if ol’ Washy is ready for the warm (and wet) handoff, can no longer be counted on to handle its obligation.
You see where I’m going with this already.
Our washer and dryer are part of an integrated system. In fact, the dryer is an integrated system all in itself. So I discovered. With my complete lack of engineering or appliance repair skills. Thus my head being inside the dryer looking around for some sort of big arrow with bright lettering pointing at something that said “HERE’S YOUR PROBLEM.” I never found that arrow, and apparently I haven’t found the problem yet either. What I did find was this little integrated system within a larger integrated model. You see, a dryer really isn’t that complicated of a machine. It essentially has one very long and difficult to install belt that runs through a very strong system of pulleys before wrapping around that big drummy thing. One of those pulley things also seems to power the fan-thing that sucks the lint out of the drummy thing and sends it shooting into the backyard. When said drummy thing spins, said fan-thing spins as well. Integrated, si? Now, there are also parts with very complicated names like “drum bearing kit” which much to my dismay had precious little to do with percussion – EXCEPT when it goes bad at which point you’d swear the Purdue Marching Band was practicing a drumline routine in the laundry room. With my minutes of experience in appliance repair, I was easily able to diagnose this part as being the culprit of all the noise, so I ordered the “drum bearing kit” and was able to change it. Still the noise. And then BOOM – broken belt. So I changed that. Put on new door glides so drummy thing can spin unabated in the track of the door once it is closed (more integrated parts!). Still the noise. But at least it works…it dries clothes, and THAT I suppose is the outcome.
So that thought that occurred to me while my head was in the dryer…Well – not THAT thought -the neighbors would complain about our dryer floating in the pond…The one I’m referring to is all this stuff about the path TO integrated care. There are presentations at most every major health-related conference now on models of integrated care, and paths TO integrated care, and steps TO integrated care…heck, I’ve done several presentations on the path to integrated care myself. We’ve got it all wrong, though.
While I was repairing the dryer (“repairing” being a very loose interpretation of the facts), it occurred to me that this integrated system I was working on was never THE goal – clean clothes were the goal.
Machines – and systems – work best only if they are efficient, effective and can work as close to maximum capacity as they can. In order to get the most return of your investment of time, money and energy, you want your machine or system to handle as much volume and capacity as it can. No one invented a dryer that only dries blue jeans or prom dresses or shower curtains. No, whatever wet clothes you put in there, the outcome will be that they will be dry – and if the washer did its part – they will be clean and dry. Our system has to function with the same expectations – the “no wrong door” philosophy. No matter what “side” you enter, the outcome is expected to be the same – you will be healthier having gone through an effective, efficient, accessible system. The difference is that we are charged with creating a super-integrated system that is both the washer and dryer. You shouldn’t have to “refer” your wet clothes to a moody dryer that may or may not be accepting new clients that day. Our reasonable expectation is that someone should be able to enter any door and achieve better outcomes as they exit. And we shouldn’t have one for jeans, one for prom dresses, and one for shower curtains. The system should be able to adjust to the needs of whatever it is presented with.
An integrated system is not the ultimate goal, its a step along the path. Our work is only just starting once we have an integrated system – it is going to require a ton of engineering, a lot of concessions, and constant monitoring and repairing of slippages, squeaky wheels and replacing of worn out parts. Our goal is healthier communities. We’ve got to pick our heads up from this path every once in a while and make sure we’re still heading toward the right goal. I suspect there are those who may want the best for their patients, but are likewise as concerned about preserving their domains. The washer people aren’t trying to put the dryer people out of business or vice versa – they depend on each other. They know their strength is in their system, in their collaboration. If somehow, someday, they could figure out how to use only one plug in the wall for both services, have only one door to be opened, and have only one internal system to be monitored and repaired, and have it be as at least as efficient as it is now, good for them. In the healthcare world, some folks are already there; while others need to figure out the collaborations between the two systems long before they could ever be conjoined in a more fixed manner. If ever. Whatever. The ultimate goal hasn’t changed.
I’ve got to get my head out of this dryer soon so we can get some wet clothes in there. As my wife has reminded me, the path to a “happier family” goes through the land of “clean clothes” so whatever I need to do to get that drummy thing spinning again with heat blowing into it, that’s what I need to do.