Clinical Change

The Greatest Constraint Hospital Leaders Overlook

The Greatest Constraint Hospital Leaders Overlook

Proactive hospital care: if you’re not certain you have it throughout your hospital, you probably don’t. And that’s incredibly costly in human as well as financial terms. Hospitals that fail to deliver proactive care are failing as hospitals.

1Unit Proactive vs Reactive Care

Standard of Care

Proactive care should be routine, of course. The logic is overwhelming. Prevent complications before they happen. Recognize deteriorating patients and respond in a timely way. Detect delays as they happen and act to minimize the impact. Stay ahead, course correct, and advance progress every day. Makes sense, doesn’t it? So much sense, in fact, it’s what patients expect.

If only they knew the truth.

Even in the most modern hospitals, proactive care on medical units is exceedingly rare. If you doubt that, search for descriptions of a legitimately proactive hospital care model – where medical care teams routinely coordinate to stay ahead of issues together.

If your search uncovers anything promising, please share it with us, or send it to me at so we can evaluate it for this blog. Real-world illustrations of proactive care are collector’s items, after all. Here’s one, by the way, for your collection:

Even better, try looking for proactive care in your own hospital. Trust me, this is something worth your time, and quite frankly is long overdue. Block out a morning on your calendar, go to a medical unit, and watch what happens. Rather than proactive care, what you’ll witness is the polar opposite.

Reactive Care

Why? Because reactive care – too little too late – is the norm. And because leaders consistently overlook it, reactive care is the greatest constraint hospitals face. The price hospitals pay for reactive care is massive. Details are missed and windows close. Complications multiply and patients suffer. Days and resources are wasted.

During the morning you’re on the medical unit, be an active observer, interviewer, and take notes.

  • How many different primary attending physicians are caring for patients on the unit?
  • How many nurses tell you they are uncertain about the care plan, or spend valuable time searching the chart for answers or paging physicians for clarity?
  • How many patients express frustration about communication from their care team or about uncertainty with their care or discharge plan?
  • How many times did the physician, bedside nurse, and patient meet face to face at the bedside to update each other on status and adjust a shared plan of care?

What you’ll witness is reactive care. It’s everywhere, in plain sight, all day long. If there’s a positive spin here, it’s this: there are tremendous operational gains just waiting to be captured by switching to proactive care.

Alright, so what does proactive care look like and what is it essentially?

What Proactive Care Looks Like

The first time you see proactive care it’s unforgettable. Chances are you’ve never seen anything like it in a medical unit, unless you happen to have seen world class transplant or geriatric units.

Proactive looks exactly like the care we should be delivering every hospitalized patient every day.

When you see it, it will look like this: the doctor, nurse, and patient all together at the bedside every morning using a standard communication protocol to exchange perspectives, to cross-check vital information, to make adjustments to a shared plan of care, and to identify actions to drive progress and recovery.

Fortunately, all the necessary contributors for proactive care – the patient, the bedside nurse, and the primary attending physician – are available in the hospital every day. Notably, additional members of the care team, such as social workers, pharmacists, nursing assistants, and family members are terrific contributors to proactive care, even if not always available.

Proactive Care 

Essentially, proactive care is team-based, patient-centered, and highly routinized. It leverages collaboration to stay ahead of the tempo of costly complications and delays.

Proactive care is highly concentrated at the bedside through interdisciplinary rounds, but also occurs throughout the day where physicians and nurses share time, physical space, and accountability for the outcomes of a home unit.

Proactive care is the engine every hospital unit must have to deliver the most efficient care possible — it’s undoubtedly where hospital care is going.

Learn more about proactive care

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