American hospitals discharged more than 30 million patients in 2013. I'm not focused on the number in that sentence, but rather, I'm stuck on a word: “discharged.” People in our healthcare world use it every day as in, “Good morning, Ms. Santiago, you're being discharged today.” The term discharge means many things as a noun and verb—none of them pleasant. Is it OK to mark the end of an episode of medical care with a word that means “eject,” “terminate,” “ooze” and “offload”?
It's not OK. Unfortunately, it's accurate.
We speak of the “healthcare system” in the U.S., but we're kidding ourselves. There's no system. It's a cottage industry of disjointed providers and locations. We don't communicate well with one another, and we're not great at coordinating appointments, charts and medications. Patients often are “discharged” into the murky waters of disconnected care, which they must navigate on their own.
It doesn't have to be this way. There's a trend toward creating real health systems that provide one-stop shopping for consumers. Great care is coordinated from one stage to the next. Value-based payments can support this movement by rewarding providers for keeping people healthy. New health-information technology also helps. Americans are paying a larger share of their incomes in healthcare costs than ever before in this era of high-deductible health plans. They want—and deserve—health networks that provide (or coordinate) all of their care.
We could wait until we've fully transformed healthcare, or we could acknowledge that what we say today will help shape the future. We could stamp out the word “discharge” right now and hold ourselves accountable to create integrated well-care systems. It won't be easy, but all of us can start using words such as “transition” and “move” so patients know they're not dropping out of our care. Over time, we can work together and with government partners to eliminate the word “discharge” from the healthcare vocabulary.
Spend four years in school and you have a “commencement,” which, as countless guest speakers remind us, means “beginning.” Leaving the hospital should be like that. It's the start of a new phase of care in another setting. Our patients and families should never be discharged. Let's eject and offload that word—starting today.
Elliot Joseph is president and CEO of Hartford (Conn.) HealthCare, a six-hospital not-for-profit system.