Thread by @usnehal

This

@bruce_y_lee succinctly says what I lay out in multi-tweet threads

This is it in a nutshell

Divide and conquer is as old as time. Ask anyone whose history includes being colonized

#Healthcare is 1/5th of the U.S. economy. You bet non-clinicians want a piece of that

If you are someone who touches patients, has ever touched patients, provides direct care, has any clinical background, I'll be totally frank, I respect your role. If your salary adds to the 30% administrative overhead of #healthare in America, then I have questions about #value.

This is a framework my coauthors and I offered on how to assess value and cut waste. Let's start with administrative burden. What exactly do you get paid to do in #healthcare? (we should be asking) What does your job do to deliver on the quadruple aim?

journals.sagepub.com/doi/abs/10.117…

We must take these questions right to the top if institutions doing this yet hire/pay low-value non-clinical staff. As a former #Medicaid medical director I've asked tough questions of my peers. All in #healthcare need to be accountable on #value.

npr.org/2020/05/10/853…

There are these hidden costs & hidden people. I get that Americans need jobs - I don't hold that against anyone. But the #1 cause of personal bankruptcy in America is unpaid #healthcare bills. So, yes, totally get a job...that helps & adds #value.

nytimes.com/2018/07/16/ups…

Instead of holding on to old ways of extracting value, dependent on turf. (By the way, most clinicians are employed so it is not your turf anyhow anymore)
...need to be thinking about the future of work, future of healthcare, future of supply chains, etc forbes.com/sites/ashleyst…

I will fully admit it: I've had it. The epidemic levels of #burnout that existed prior to #COVIDー19 were already driving harm to all - patients, clinicians, the system, the bottom line. @EricTopol is spot on here. This is betrayal. medscape.com/viewarticle/92…

To be clear, some non-#clinical staff ARE frontline & high #value, like environmental services

A @MITSloanFellows peer had a business idea to monitor cleaning staff. I did not mince words. Could lead to #bullying. She listened
healthaffairs.org/do/10.1377/hbl…
@Health_Affairs #MedTwitter

Yes, I am not touching patients this year. Struggled w/ that decision once pandemic rose & had simultaneous offers to join @MITSloanFellows as a Dean’s scholar (covers 10% of cost) or serve+earn salary in #NYC in another CMO role overseeing 10 centers.

linkedin.com/posts/usnehal_…

I knew I would be facing these same challenges that other mission #publichealth leaders face, especially mission driven WOC answering up food chain to #business execs - was I equipped to be more successful than other #NewYorkTough women?

No, am not.

nytimes.com/2020/08/04/nyr…

Would I have, in addition to the title, have actual support and back up to do and say the right thing?

I was the rare licensed physician willing to be quoted in this article by @MarketWatch @Quantanamo - often possessing a license puts one at risk for retaliation.

Not ok.

Admit, am nigh obsessive in my documentation, thus safer than some of my peers. Should anyone try to retaliate, they would end up under a mountain of documentation & never dig out. (That is also how I never lost a public hearing for the Commonwealth) Cuz:

bloomberg.com/news/articles/…

In particular, non-#clinical staff whose surveillance is #bullying and/or silencing on issues critical to #quality, #safety, #safetyculture = unacceptable level of harm

Cut the waste.
Let’s have functional teams and healthy culture.
Let’s get back to heart of matter

Instead, let’s commit to #healthcare #transparency - requires trust, community, culture, psychological safety. Today is @donberwick’s bday. @harvardmed #Pediatrician who founded @TheIHI. He left a traditional system to create a new #mindset & #framework

ihi.org/communities/bl…

This is personal on many levels. The system I willingly sacrificed my 20s to almost killed me

I am thankful for the courage of this trainee who caught what (attendings, experienced nurses, employed pharmacists, etc and) everyone (else) missed

Speak up
Save lives
#MedTwitter

Nor can I tolerate even one more clinician suicide. I just can’t

Yes, all of this is very personal

We must not allow our service, commitment, courage, or sacrifice to be exploited any longer

Convert current system waste & barriers to #safety & #value

nytimes.com/2020/07/11/nyr…

If you are a frontline worker, environmental services, doctor, nurse, receptionist, delivery person, you are dealing with this

as compared to those hiding behind computer screens offering #HealthCareHero for optics

Need: resources
Need: results

nytimes.com/2020/05/16/hea…

There is waste & harm in healthcare
Go after that

“administrative complexity, $265.6 billion”

“estimated total annual costs of waste: $760 billion-$935 billion

There are shared harms to all at frontline

Let’s not compound that harm
#MedTwitter

jamanetwork.com/journals/jama/…