In 1968, McDonald's introduced the Big Mac to the United States. What was it about the Big Mac that resulted in sales of over $1.5 million per day? It was not the two all-beef patties, lettuce, cheese, pickles, onions, or the sesame seed bun: Most of the burger places had that. The secret to the Big Mac's success was the "special sauce." Anyone could sell burgers, but McDonald's created a special, secret sauce that made their Big Mac an American classic.
Their idea of a "special sauce" ingredient to distinguish their burger is something we may be able to learn from in regards to healthcare.
A flat world
With automation and technology, much of healthcare has become mechanized, relying more and more on devices and diagnostics. Patients can now connect a device to their smartphones to emulate a stethoscope, an echocardiogram, an otoscope, or even to perform enzyme-linked immunosorbent assay testing.1 Patients sometimes try to take charge of their care, plugging their symptoms into an Internet search engine and calling their healthcare providers to tell them what they think is wrong and what they need. Will the human encounter become obsolete? Technology has its benefits, but it can also lead to unnecessary testing, overtreatment, missed diagnoses, and can distract from the human relationship in healthcare.
Thomas L. Friedman, in his book The World Is Flat: A Brief History of the Twenty-First Century, outlines how things like the Internet, technology, and outsourcing have "flattened" our world, creating a much smaller, more integrated world while eliminating the need for many traditional jobs.2 People are being replaced by electronic devices or by people in another country who do the same or better work for much less money. Friedman says that to succeed, we need to create what he calls our own "special sauce."1
People want something different from the usual "flavors," or traditional services. For health and healthcare to flourish, we must offer something different, unique, and special that cannot be done by a machine. The "special sauce" is what distinguishes what we do from what everyone else does. As McDonald's did to make a unique burger, so we must do to excel in healthcare.
The current debate regarding healthcare has more to do with paying for healthcare than how we practice it. There have been some changes in what is covered in the proposed programs or required services for certain conditions, but it is primarily the same inefficient, expensive, and automated healthcare process. Healthcare should be available to everyone, but besides making it available, it must go beyond symptom treatment to educating, motivating, and caring.
Treating symptoms is not enough; we need to treat the individual. Healthcare needs to go beyond what everyone is doing to having a "special sauce" that will provide a unique component of healthcare that makes a difference.
Paying for more people to receive current healthcare, with its assembly line approach of box checking and treating all patients as if they have identical risks, goals, values, and preferences, does not improve health or result in efficient caring. Industry influence and pay-for-productivity have resulted in more of a "health profit" system than a healthcare system. We get paid for doing procedures, seeing more patients, and even asking certain questions, but no one is paid for better health.
The art of healthcare
Friedman sees the solution as broadening our perspectives and doing less compartmentalizing: "But more than ever our secret sauce comes from our ability to integrate art, science, music, and literature with the hard sciences."1 The real "special sauce" we need in healthcare is not a device or a thing; it is not something we can put in our hands or a pill that patients can put in their mouths. The thing that will separate human healthcare from mechanized healthcare is the relationship.
Healthcare is an art, not a science. It must integrate each patient's desires, goals, and preferences into the process. There is no one-size-fits-all algorithm or single right way that works for everyone. We must build a relationship to understand the needs and situation of each patient while helping them find hope and purpose in life. This is not something that can be institutionalized. It will not come from politicians or insurance companies, from regulations, expert panels, or guidelines. It will happen when we choose to use our imagination to change the way we do things in ways that put the individual ahead of the institution.
Integrating behavioral health
Building relationships with patients starts with the premise that every person carries a burden or faces some type of struggle. It may be from childhood, relationships, and economic or living situations. Whether or not we are aware of it, we are all broken in some way. We may go through life ignoring or burying our struggles and putting on a smile as if everything is fine. But these burdens affect our health. Our bodies express real, physical symptoms in response to emotional struggles. Conditions such as a weakened immune system, ulcer, headache, rash, or hypertension may be the manifestation of these struggles. We do not solve the problem by treating the symptoms.
Listening beyond the symptoms-listening attentively with the heart-allows patients to tell us what is really causing the problem. The real integration of behavioral healthcare into physical health is not simply to have a separate behavioral health worker in the same facility but rather for each clinician to integrate the patient's body, mind, and spirit into each encounter.
The majority of patients I see each day share with me some kind of issue beyond their rash, cough, palpitations, or other symptoms, which is more the cause of their symptoms than the integumentary system, the pulmonary system, or the cardiovascular system. Humans have categorized and compartmentalized these systems, but the underlying causes often go beyond the specific system. The body, mind, and spirit are so intricately intertwined that only through this human touch can we truly foster health and healing.
Computers have been programmed to think, to take a list of symptoms and spit out a diagnosis. Using preprogrammed algorithms, the computer can also determine a treatment. But we do not treat diagnoses-we treat patients. This is the heart of nursing. We treat the patient, not just the disease. The real "soul" of the interaction comes from the care we give from our hearts. The "special sauce" we add is what we say and do that helps the patient feel cared for, heard, and hopeful at the end of each visit.
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