Systemic Failures

The 12 narratives highlight persisting structural failures of health care delivery systems, which marginalize and disempower patients. These systemic failures coalesce around three major, sometimes overlapping forces. First, financial incentives drive virtually every aspect of health care. Given high costs of doing business, private and public health care providers alike constantly maneuver to minimize financial risks. Second, upon hospital discharge, many patients fall through the cracks, as they transition from the silo of inpatient facilities into another and separate silo, community-based long-term services and supports. Patients leaving inpatient facilities can find themselves in environments ill-suited to support their needs. Third, structural forces affect communication between patients and their health care providers. In particular, major payors, notably Medicare, punish hospitals financially when patients are readmitted shortly after discharge, leading hospitals to prioritize pre-discharge communication. However, discharge planning is often inadequate, leaving patients without essential information to effectively manage their health.