Our health care delivery system is broken at the microcosmic space between the nursing station and the bedside. All the energy and attention has drifted up and away from patients. Nursing intuition has given way to adapting to ever more complex process. All the money is siphoned off into committees and facilities and ever more impressive technology. The health care enterprize is thoroughly bureaucratic and virtually no one operating within it is satisfied. They adapt or leave. Compassion fatigue runs rampant, its consequences can be dreadful.

    Managing process is futile. Nothing good comes of it, it just wears out the participants. A better way would be a focus on outcomes delivered. Let the money flow to where the outcomes delivered are superior. 

    This does not happen now because the health care insiders have lost confidence in their ability to deliver credible health care outcomes. One senior executive of my acquaintance told me that her hospital delivered the national average with respect to bedsores. As the person responsible for quality she thought that this was an achievement. National average results an achievement? She too, stopped taking my calls.

    If bedsores were an outcome to be avoided rather than an inevitability we might begin to approach a solution to the problem of rising cost that has seemed to defy solution since 1965. Who knows it might even save Medicare. I contend that the bedsore is at the center of a solution to this seemingly intractable problem. Getting a responsible party to sit still long enough to think it through has been my seemingly intractable problem.

    In my mind's eye I visualize the day when a collaboration with someone like SunMicroSystems will lead to a quantum leap forward in health care delivery. When we can begin to see quality outcomes guaranteed, starting with bedsores, we can add other outcomes that will be equally beneficial. I believe that bedsores prevented for less cost than we presently expend for treatment is demonstrable. It could be guaranteed. Finding courageous people with the adequate vision to see the implications of such a first step seems to be the impossible task. Yet not one person has, after examining the case, refuted me in any respect. They just go silent. It is this quality in our best and brightest that is killing us.