Where are the Lollipop Men in Healthcare?

9 04 2012

I recently watched Dr. Atul Gawande on video describe how what American healthcare needs is pit crews and not cowboys.  This sentiment is also memorialized in his thought-provoking writings for the New Yorker.

Interestingly, Dr. Gawande is not the first person I have heard to suggest such a thing.  A colleague named Dr. Ken Catchpole actually studied Formula 1 pit crews and used the information to guide improvements in pediatric anesthesia handoffs.  His observations were astounding and really highlighted how the culture of medicine is different from Formula 1. In Formula 1, pit crews have a ‘fanatical’ approach to training that relies on repitition.   In healthcare, the first time we often do something is “on the fly”.  Moreover, on-the-job training usually means ‘checking the box’ by attending an annual patient safety lecture.   Perhaps the most important was the role of the “lollipop man” in pit crews.   And yes, even thought it’s a funny name, it’s a critical job.   As shown in the video, the Lollipop man is responsible for signaling and coordinating to the driver the major steps of the pit stop.  When it is safe to step on the gas, the Lollipop man will signal to the driver.  Sounds like a thing so perhaps it can be automated.  Wrong.  When Ferrari tried replacing the Lollipop man with a stop light that signaled the driver, the confusion created (does amber mean stop or go?) led to a driver leaving the pit with his gas still connected.  Quickly after this incident, Ferrari announced it would go back to the tried and trusted Lollipop “hu”man.

So, who are the Lollipop men (or women) in healthcare?  Turns out that Dr. Catchpole and his team observed that it was often unclear who was leading the handoff process that they were observing in healthcare.  With team training and system reengineering, Dr. Catchpole’s team was able to reorganize the pediatric handover so there was a Lollipop man (anesthesiologist) at the helm.

While these handoffs represent a critical element of healthcare communication in a focused area, it is symbolic of a larger problem in healthcare – we are still missing “Lollipop men” to coordinate healthcare for patients across multiple sites and specialties.  This is even more critical on the 2-year anniversary of healthcare reform and this month’s match results. At a time when we need to cultivate and train more “Lollipop men” to coordinate care for patients, we have had stable numbers of students who enter primary care fields.   And like the lessons from the Ferrari team, it is doubtful that a computer (even Watson who is now working in medicine apparently) will be able to do the job of a Lollipop man.

So, how can we recruit more Lollipop men?  While it is tempting to blame the rise or fall of various specialties and market forces, it is important to recognize that being this is a difficult job to do when the Lollipop is broken or even nonexistent.  Without the tools to execute the critical coordination that Lollipop men rely on, they cannot do their job.  So, the first order of business to ensure that the Lollipop, or an infrastructure to coordinate care for patients through their race that is their healthcare journey, exists.  As the Supreme Court debates the future of the Accountable Care Act, there is no greater time to highlight the importance of the Lollipop.

–Vineet Arora MD

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3 responses

9 04 2012
Mary Beth Newman

The “Lollipop” men (or women) you’re looking for already exist and they are called Case Managers! Promoting effective transitions of care is one of the key responsibilities of case managers–health care professionals who are experts at care coordination. Case managers are a key member of the interprofessional collaborative care team not only in the acute care setting, but in settings throughout the care continuum. I’d suggest a visit to the CMSA website (www.cmsa.org) to learn more about who case managers are and the critical role they play.

10 04 2012
WHowland MN RN-BC CRRN ***CCM*** CNLCP

It is disheartening in some ways, and should be embarrassing to these physicians, to realize that in the 21st century not all controllers are men, that we don’t need more physicians to be trained in these actions, and that certified nurse case managers have been providing precisely these services for many years. Albeit often with less support from physicians than we deserve.
I guess now that a physician has come up with the idea, it will become the next BIG THING. Lollipop men, my grandmother’s sweet patootie. Look around.

10 04 2012
futuredocs

Thank you for your comment. I have worked closely with case managers and share your enthusiasm that they can serve this role for ensuring a care transition goes smoothly. If one takes a specific process in healthcare, you can imagine many types of “lollipop men.” The question is what is needed when we think about the broader picture of deciding on the care a patient receives across the entire spectrum of care for complex medical patients? A medical home will need a leader. While there is potential for nonphysician clinicians in this role, a primary care physician is still going to be the critical central role for the most complex medical patients who are the high cost patients that everyone is focused on. Of course, those patients also need great case managers, so I think its safe to say the 2 are surely complements, but not substitutes for one another!

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