It's a small world.

Half way through a study tour of the Boston Healthcare system there are a few key points bubbling around the group.
Before I move to that it would be remiss not to mention the very warm welcome expressed by all the people we have spoken to, from "ward to board" in every Hospital or care setting we have visited.
So what are they saying?
Like the UK American healthcare is not broken but needs fixing. It is in the foothills of a politically instigated reorganisation which will also be visible from space.
I took the decision to view the trip through the lens of sustainability, i.e. Value, Toxicity, Waste and Evolution.
US healthcare does set out to deliver value and is working out what that means, we met a surgeon who is collaborating with Michael Porter, the father of Value Stream Analysis, we heard from providers keen to demonstrate quality through adoption of external standards such as Magnet Accreditation, we met providers who recognise that cost reduction is sine qua non for survival, so the equation value= quality/cost was visible as a thread.
Avoidance of Toxicity shone through at Mass Generals modestly named "the future of ambulatory care practice". This Physicians office based service has completely stripped out the old processes and assumptions which could shackle us to practices of the past. Direct access by e-mail triage, proactive management by a multi disciplinary team, patient rooms not doctors rooms, virtually all toxic habits and accumulations abandoned. Whether it could be delivered in a system that is set in its ways is unsure. The lead physician describes it as a "start up" and it most certainly is.
The reduction of Waste was a main driver behind one provider units use of Magnet Accreditation, in a Hospital where the senior team has been in place for over a decade, the concept that nurses could leave after being trained and developed seemed like a waste, so they undertook an onerous project to achieve a standard which makes them attractive to nurses and reduces absenteeism, turnover and unhappiness with career path.
Evolution is not something you see directly, it deals with timespans greater than our visit allowed, but even so the evidence of natural selection was everywhere, new buildings and developments in some sites, integrated or hybrid theatre suites in others. Reduction in length of stay to two days after a hip replacement and then returning home is impressive.
Will this make the US system sustainable? Is the "big bird" of American healthcare an Auk (extinct) an Ostrich (struggling) or a Turkey (seasonally overpriced) ?
It's impossible to say, but there are certainly signs of sustainability that can be taken back across the pond. it is a small world.