Last month in this space I identified four structural impediments to innovation. They were the lack of an aligned financing mechanism, overly burdensome regulatory structure, disconnected educational programs and a workforce that reflected the first three. There is one more barrier that is not as tangible as these four, but may be an even bigger impediment to innovation: individual clinicians’ reluctance to change.
One issue many health care professionals are averse to changing is moving from an approach to care that focuses on individual practitioners and “their” patients to one in which health professionals work together in a system to advance the health, well-being and satisfaction of all of the individuals they work with. This transition requires that many clinicians redefine some of their traditional and deeply held values. It does not necessarily mean giving up one value in exchange for another but rather balancing the traditional approach to care and professional behavior with emergent demands, new resources and new realities.
Creating this balance will require commitment to individual excellence and responsibility in addition to understanding that the highest level of care is possible in a system in which quality interactions at every point of contact are the norm. This broadens the old model of the solo provider taking on all of the responsibility and direction of care and service to include the entire service team, both clinical and non-clinical. Everyone on this team must be fully engaged and aligned so that their actions can serve their patients’ needs. If the team isn’t aligned, the reluctant individualist of the old school will have one more justification for “not going along.” But once such engagement is achieved, the team will be able to implement a systems approach to deploy evidence based practice patterns, build supportive technology, and use a broader and richer set of team inputs (including the patient) which will inevitably improve the quality of care and allow for a more effective use of individual and collective resources.
Pushing this innovation is the need to change the current orientation of the health care system from its almost exclusive focus on episodic treatment of acute care needs to one that allocates resources to ongoing prevention and improved management of chronic conditions. As the population ages in the US this need for balance will become more important. This also means that the practitioner must be willing and able to move from their comfort zone of treatment in order to accommodate issues of patient lifestyle, preferences and choice. This is a messy world for most health professionals. They often know what intervention needs to be done, but there is a growing number of other considerations to manage in the health encounter. This may require the practitioner to share power and authority with the patient in ways that will be uncomfortable for some, but changing in this way may be essential for much needed innovations.
Henry Ford once famously said about the Model-T that, “you could have any color you wanted, as long as it was black.” For many years health care has had a similar consumer orientation and, because there were few alternatives, most people either accepted it or went without care. Today we see developments that point to the unsustainably of such an approach. The first is the proliferation of great variety of complimentary and alternative providers. Regardless of their clinical merit or outcomes data, the public’s attraction to these choices should chasten any health care provider’s attitude that all consumers are satisfied. The second reality that should give us concern is the shocking disparity of health care outcomes among populations in the US. Some of these differences are undoubtedly a product of lack of understanding and responsiveness to patients that are not comfortable with the dominant culture of health. This issue will only be addressed as those within health care shift their preferences about how service is delivered and turn to patients with a new eye for customer service. I know that many clinicians may be uncomfortable transitioning from perceiving patients as customers, but for those who have such reactions I would ask why a “patient” should be powerless and take orders from a professional? Why not balance this in part with the relationship of provider and customer and redistribute power a bit?