On a bright blue-sky, sunny November day in Cape Canaveral, a rocket blasts off with all the roaring noise, flames, smoke and hold-your-breath anticipation that give onlookers goose bumps. These are the first seconds of a nine-month mission that would carry Curiosity to the legendary Red Planet.
Launches are always dramatic, but this time the landing stole the show. As it approached Mars, the pull of gravity accelerates the spacecraft to 13,000 mph. Then, the atmosphere passing over the heat shield slows it to 1,000 mph. A huge parachute pops up and the heat shield drops off. The parachute is cut away and descent engines kick in. The spacecraft plunges toward the surface at 200 mph.
Now for the grand finale. Curiosity, often described as about the size of a Mini Cooper, is lowered by cable from the hovering rocket stage and lands at a cushy 1.7 mph. Curiosity phones home, and Mission Control becomes Mission Joyful Chaos.
The future will show how valuable a scientific venture the rover will be. But there's no doubt that the landing was an astounding triumph of engineering — breaking incredibly complex tasks into a series of sequential workable maneuvers.
No doubt rocket science is complex, but so is health care. Running a hospital is one of the most difficult jobs on earth. One episode of care can involve hundreds of people and any number of procedures and tasks that must be done exactly right. Curiosity is programmed to do exactly what it is told. Hospitals are filled with dedicated workers of various levels and skill sets. Each step taken — or not taken — affects the course of a patient's life. They are highly educated and trained, but they are human, not programmed, and in many cases, there is no overall prescribed system to govern their actions or a set team mentality to coordinate their different contributions.
In his recent article in The New Yorker, "Big Med," Atul Gawande, M.D., argues that the next phase for the large systems growing across the country is to standardize clinical care across their entire systems to improve quality, control costs and speed innovation, which is notoriously slow in health care, at an astounding 15 years from inception to practice. He uses words like "regimentation" and "oversight" — not welcome words to those who defend the "art of medicine." He predicts consumers will gravitate to this standardized, coordinated approach and that patients won't look for the best specialist anymore, they'll look for the best system of clinical care. That's the Big Picture.
Now let's look at the Hot Spotters. Hot spotting targets specific conditions and patient populations for intervention. They use data and personal observation to identify high utilizers. Some are the "medically fragile" elderly; others have multiple chronic conditions; some have complex behavioral health problems. Teams assemble to work face-to-face to engage them and identify problems and barriers to better health — often getting down to the details of how they live and function. When successful, the reduction in hospital costs can be dramatic.
Far different approaches, but each is a coordinated system of care. If we are to have a happy landing in our turbulent era, both will be sorely needed.
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