Thank you for these insightful recommendations. I particularly appreciate the focus on interdisciplinary governance and review. In addition to the physician, nurse, APP, respiratory therapist and perfusionist leadership, I would respectfully add Social Work leadership for several reasons. In addition to their unique systems perspective, their expertise in mental health and social drivers of health are critical voices to include and impacts all patients in the hospital.
Great call adding Social Work to the list. The systems lens is reason enough, but the mental health and social drivers piece is huge, and it touches every patient in the building, not just the ICU. Easy to overlook exactly because their impact is everywhere instead of tied to one order set. I'm folding this in. Thanks for sharpening it.
You frame the gap as two failures: either hospitals can’t operationalize what they bought, or the deployed tool isn’t the one that was cleared. I’d add a third reading, the uncomfortable one.
“Not routinely used” sounds passive, as if nothing has happened yet. But a great deal has. The adoption was announced, the transformation narrated, CommonSpirit’s hundred-million-dollar figure booked. For the hospital, the vendor, and the regulator, the deployment has already delivered its product: legitimacy, innovation, a leadership win. The only party still waiting on the actual deliverable is the patient, who cannot point to one changed encounter.
That is what makes the gap morally unstable rather than merely immature. It may persist not because governance hasn’t caught up, but because, for everyone positioned to close it, the transaction is already complete. Deployment was allowed to count before care changed, and once something has counted, the pressure to make it real quietly fades.
Which is the hard thing beneath your governance prescription, and I think you are right to press it anyway. You are not asking institutions to finish closing a gap they want closed. You are asking them to reopen a success they have already booked and convert it back into an unpaid obligation. The debt is real; the trouble is that no one who profited from the deployment is its natural creditor.
Thank you for these insightful recommendations. I particularly appreciate the focus on interdisciplinary governance and review. In addition to the physician, nurse, APP, respiratory therapist and perfusionist leadership, I would respectfully add Social Work leadership for several reasons. In addition to their unique systems perspective, their expertise in mental health and social drivers of health are critical voices to include and impacts all patients in the hospital.
Great call adding Social Work to the list. The systems lens is reason enough, but the mental health and social drivers piece is huge, and it touches every patient in the building, not just the ICU. Easy to overlook exactly because their impact is everywhere instead of tied to one order set. I'm folding this in. Thanks for sharpening it.
You frame the gap as two failures: either hospitals can’t operationalize what they bought, or the deployed tool isn’t the one that was cleared. I’d add a third reading, the uncomfortable one.
“Not routinely used” sounds passive, as if nothing has happened yet. But a great deal has. The adoption was announced, the transformation narrated, CommonSpirit’s hundred-million-dollar figure booked. For the hospital, the vendor, and the regulator, the deployment has already delivered its product: legitimacy, innovation, a leadership win. The only party still waiting on the actual deliverable is the patient, who cannot point to one changed encounter.
That is what makes the gap morally unstable rather than merely immature. It may persist not because governance hasn’t caught up, but because, for everyone positioned to close it, the transaction is already complete. Deployment was allowed to count before care changed, and once something has counted, the pressure to make it real quietly fades.
Which is the hard thing beneath your governance prescription, and I think you are right to press it anyway. You are not asking institutions to finish closing a gap they want closed. You are asking them to reopen a success they have already booked and convert it back into an unpaid obligation. The debt is real; the trouble is that no one who profited from the deployment is its natural creditor.