Issue link: https://beckershealthcare.uberflip.com/i/1169964
93 FINANCE CMO / CARE DELIVERY Q: Dr. Miller, you said in your TED talk that we're "asking too much" of hos- pitals, which are "no place to live and die." With this in mind, what do you think we can ask of hospitals? Do they have a role to play in end-of-life care? BJM: e hospital setting is more stressed than it deserves to be or is designed to be. Hospitals are the pinnacle of acute-care, which is really meant for urgent issues that can be cured, or at least slowed down. And there's a disconnect, because we're increasingly dying from chron- ic illness, not acute illness. Dying is really not an emergency. When you're dying, there's not much to be done anymore. As we become a more secular society, I think the hospital emer- gency room has become the modern church: It's where people go for all their problems. But it's unfair to ask that of our acute-care hospitals. I don't want to let hospitals off the hook, of course, because some people are still going to end up dying in hospitals. I do think more can be done. We could train staff to better accom- pany people through the transition from acute -care to comfort care, for example. We could also improve hospital design. Hospitals are de- signed to move people through them; they're not designed to be pleasant places to hang out. I would love to see a new hospital that has places for families to be during loved ones' final hours, or that gives patients better access to natural light and a window, among other things. Better design could make hospitals places where pa- tients could still feel inspired and wouldn't mind having their final moments, if need be. Q: Ms. Berger, do you think design could play a role in other areas of healthcare? Several problems in healthcare seem to be the result of poor design. SB: ere are a lot of great stories about de- sign-minded people in hospitals. e designer Michael Graves famously said, "I can't die in here. It's too ugly." And Ideo is seeing health- care concerns come to the table more and more. ere are touch points all through the hospital experience that could use a redesign, from the moment you enter the waiting room in an emergency department, to how nurses and staff engage with patients, to the actual design of the room. It's not just an enormous challenge, but also an enormous and un- tapped opportunity. e designer Yoko Sen, for example, has a whole point of view around the toxicity of noise in hospitals. She's trying to create noise-canceling music that will wash out the cacophony of hospital alarms with more palliative sounds, since alarms can cause patients stress and increase their heart rates. Q: Dr. Miller, your colleagues told The New York Times you have a talent for establishing warm and trusting relationships with patients, even though you often talk with them about uncomfortable subjects. Can this kind of rapport with patients be taught? BJM: Yes, so much of this can be trained and learned. Each of us has our own inborn strengths and weaknesses, but a lot of that is malleable. If I were to cra a training program to help clinicians build a rapport with pa- tients, it would come down to two things: first, cultivating the skill of not running away from things you can't fix. I don't know any patients who are angry that their physician didn't somehow beat God and work miracles. But I do know plenty of patients who are angry at their physician for abandoning them, for not returning a phone call or not acting like a de- cent human being during difficult moments. A second thing I would transmit is to bring your own experience into your work and reveal yourself to your patients. I have an obvious source of suffering because if you take one look at my body you know I've been through some stuff. I can get to an allegiance with my patients more quickly than some of my colleagues because of that, perhaps. But young clinicians certainly don't need to am- putate something to learn about this. My suf- fering is just a little more obvious. Everyone has some example of loss in their life or some form of wound. We're all lost, confused, wan- dering souls at times. We could all wear our lives on our sleeves a little bit more than we do, which can help us connect more deeply with our patients. n Former Molina CEO named founding dean of California medical school By Alia Paavola T he Keck Graduate Institute School of Medicine in Cla- remont, Calif., has named the former longtime CEO of Molina Healthcare its founding dean. J. Mario Molina, MD, served as the CEO of Molina Health- care, a managed care insurance company founded by his father, for 20 years. He was fired in 2017 by the board of directors who cited the company's disappointing financial performance. In his role as founding dean, Mr. Molina will be responsi- ble for driving the vision, planning and development of the medical school. He started in his role on Aug. 21. Mr. Molina said the process of opening the medical school will take several years, according to the Los Angeles Daily News. Keck Graduate Institute announced plans to build a medi- cal school in July 2018 to meet the increasing demand for primary care physicians in Southern California n "As we become a more secular society, I think the hospital emergency room has become the modern church. ... But it's unfair to ask that of our acute-care hospitals." — Dr. B.J. Miller, palliative care physician