Some of us remember Mike Mulligan and His Steam Shovel, a child’s book by Virginia Lee Burton published in 1939. It is a story of change and adaptation. Mike's steam shovel is named Mary Anne. Both Mike and MaryAnne are being replaced by modern diesel-powered shovels. They go to a small town to look for work but find that they have literally dug themselves into a hole from which they cannot escape because they have not planned an exit. I won't spoil the story, but, I recommend that you read it. Captain Kangaroo read it, it became an HBO animated short and was posted by the National Education Association as one of the top 100 children’s books. Mike Mulligan was no longer a steam shovel operator, and Mary Anne, his steam shovel used her power for something else. Their pride, their skills, and their contributions became no less. They just changed.
Over 60 years later, dirt is still being moved, not by a steam shovel, but by the team work of two very skilled operators of a dozer and excavator. New names, same job. Move dirt. Same job, done better, needing more coordination. One pushes, the other lifts. Sometimes in sequence, sometimes at the same time. Each has a specialty. Each has an instant when one is “more important” than the other. By paying attention to each other, they finish the job elegantly and efficiently.
An Example of Working in Collaboration
These “tales” of moving dirt offer interesting lessons. Healthcare is different now than in the past. We still (should) help people heal or suffer less. Our tools are different. Yes, there are new innovations such as a computerized, recording, controlling IV pumps instead of a roller wheel on a tube. Similarly, the tools to provide true medical collaboration in healthcare are also different.
Hybrid store-and-forward is more efficient than videoconferencing. The diesel replaces the steam engine. Hybrid store-and-forward replaces videoconferencing. But, that change is merely a change of technology. As providers of healthcare (for all of you outside of the Washington beltway, “providers” means doctors, nurses, aides, therapists), our intent and purpose need to be changed as well. We need to develop a culture of medical collaboration, collegiality and coordination of care that emphasizes shifting roles and responsibilities, rising over hierarchy and accountability. We need to accept that healthcare as we know it is changing just as steam power changed to diesel power. While the foundation beneath our feet crumbles, we will move on and work with each other. We will regain a satisfying career and enjoy a productive life. As we move on, our patients will again have access to quality care, our satisfaction will increase as we collaborate, and we will have real experience to share as we educate those who come after us. Hybrid store-and-forward is the bridge to do so.
An Example of Working Without Collaboration.
We can dig ourselves into a hole, or we can plan to work in a better way.