I’m not certain that this is what Natalie Merchant and company had in mind when they named their 1987 release, but listening to Seth Godin speak about founding a movement and leading your tribe, I couldn’t help but think of the album name. He reached me on a personal level with my own quest to bring critical care at the Denver VA hospital, kicking and screaming if necessary, into the modern age. This is my movement. My tribe are the nurses who are bored with the run of the mill – those who want to build their skill set and take care of sicker patients, the physicians in training who want to take the autonomy they are implicitly granted at the VA and learn about taking care of critically ill patients on the front lines, the medical students who really don’t get any meaningful critical care exposure until their fourth year – if they get it at all, and my physician colleagues with a similar desire to take their game to the next level.
Of course, I haven’t gotten very far yet. I have the picture painted, and I am heading in that direction, but I lack the critical mass to surmount the inertia in the organization, the budget deficit our facility faces, and the relative back seat that inpatient subspecialty care takes in the VA system at large. As my colleague, the chief of surgery, and I have discussed numerous times, what we need is a change of culture. We need to improve the level of care we deliver, not just massage the numbers and allocation of beds to make our utilization management look better on paper. We need a commitment to delivering the highest level of care – in our hospital, 24 hours a day, 7 days a week – not just from 8:00-5:00 on weekdays that aren’t federal holidays.
One of the statements Mr. Godin made resonates particularly – maybe I just haven’t done enough to upset the status quo. That may be the trick – to get people riled up enough to want to do something, but not so riled that I lose my credibility and momentum. That forms a nice segue into my networked learning space about professionalism in medicine. Maybe I will figure out how to proceed as this community grows.
(Still under construction, but here is where I am so far:)