Reports from the Bedside: Observations on the ‘NMP’ Culture Endemic in many US Health Systems
In the fast-paced and complex world of acute healthcare in the United States, the ‘NMP’ (Not My Problem, see New England Journal of Medicine) culture continues to compromise patient care quality, outcomes and experience for many. Historically and pre- EHR era, the code was occasionally noted as ‘NMP’ in physician notes, the practice remains embedded in the predominant and prevailing specialist culture found in most U.S. healthcare systems. The feature is particularly evident in academic medial centers and their affiliated teaching hospitals. The NMP practice is characterized by a lack of accountability, less than ideal teamwork, and most certainly compromised empathy, leading to detrimental effects on patient centric care and overall healthcare outcomes. In this article, I address the root causes of this problem and explore potential solutions to advance the triple aim, i.e., better experience of care, better outcomes at lower per capita costs.
Understanding the ‘NMP’ Culture
The NMP culture is a creature of a combination of factors within legacy U.S. healthcare. One key element is the fragmentation of care, where different clusters of specialist and sub-specialist physicians theoretically ‘supported’ by an army of related allied health clinicians, and host institutions operate independently. This compromises effective communication in team based care models deployed by sacred cow department heads. This often uncoordinated and silo-ed approach fosters a sense of detachment (aka NMP) hindering effective team based collaboration among otherwise engaged health professionals.
Moreover, the heavy workload, historical internecine power struggles between medical staff, nursing, administrators, and often non-compliant patients (especially those in head or brain injury units) and/or their family members, and demanding nature of healthcare contribute to a culture of burnout. Thus the need to ‘check out’ or distance themselves from the patient and even other members of the care team – sometimes in a passive aggressive style. Overworked and stressed healthcare providers may inadvertently adopt an NMP mentality as a coping mechanism to protect their emotional well-being. This, in turn, negatively impacts the quality of care they deliver.
Consequences on Patient Care
The consequences of NMP culture on patient care cannot be overstated. When healthcare professionals prioritize their own, perhaps narrowly cast, responsibilities (i.e., documentation for billing, QA, or other internal or external reporting requirements) over the overall patient experience, gaps in care are likely to surface. Patients may encounter fragmented treatment or worse treatment, missed or misdiagnoses, medication errors, and delays in receiving necessary care. These lapses can lead to compromised patient safety and suboptimal health outcomes.
Solutions to Overcome the ‘NMP’ Culture
Addressing the NMP culture requires a multi-faceted approach that involves various stakeholders within the healthcare system. Here are some potential strategies to foster a patient (v. historically provider) centric culture of collaboration and accountability. Absent same there is no holistic 360 vision of the patient’s experience or needs:
- Enhancing Communication Channels: Implementing robust communication systems that facilitate seamless information sharing among healthcare providers can bridge the gaps created by fragmentation. This includes the integration and optimization of electronic EHRs and associated workflows and secure messaging platforms to ensure timely and accurate exchange of patient information.
- Promoting Teamwork and Collaboration: Encouraging interdisciplinary teamwork through initiatives such as regular team meetings, case discussions, and collaborative decision-making can foster a sense of shared responsibility. This approach promotes a patient-centered care model and discourages the ‘NMP’ mindset.
- Emphasizing Empathy and Patient Advocacy: Incorporating empathy training into healthcare education programs and continuous professional development can help healthcare providers recognize the importance of patient-centered care. Additionally, empowering patients, their proxies and/or family members through education and shared decision-making can contribute to a more proactive and engaged healthcare experience.
- Prioritizing Work-Life Balance: Recognizing the impact of burnout on healthcare professionals is essential. Implementing policies that promote work-life balance, offering mental health support programs, and encouraging self-care can help reduce burnout and mitigate the NMP culture.
Take Away and Policy Implications
NMP culture in U.S. healthcare poses significant risks, challenges and upside to patient care and overall health outcomes. By acknowledging its root causes to implement targeted solutions, we can begin to foster a culture of accountability, teamwork, and an empathetic patient centric care team. Embracing open communication, promoting collaboration, and prioritizing patient-centered care will pave the way for a healthcare system that truly puts patients first. We must re-examine the influence of our prevailing fee-for-services or ‘production’ driven medicine (do more to earn more) financing and delivery paradigm to transform a too often calcified and transformation resistant health system culture.
We must do better! Lives are on the line.
Author’s note: written from the bedside of a head trauma patient admitted to a teaching hospital affiliated with a world class medical school in New York City.
This article was originally published on Health Innovation Media and is republished here with permission.
It’s official. Anthony died 9:48am Eastern time. He waited for the love of his life Lauren to arrive then get let go. His heart stopped and I authorized the DNR. He is gone. Now In a better place. Reunited with Squeak (his favorite cat), Lynne (his Mom), and other passes souls. https://t.co/5dJuaIb7vt
— Gregg Masters MPH (@GreggMastersMPH) June 11, 2023