Now What?

The inauguration is over and our new president seems very busy. Appropriately, there is a lot of attention on the economy, critical international issues, and whether civility can sprout in DC. Everyone I know has read the new HHS Secretary’s book [1] and everyone has great confidence that we will soon be moving forward. So it must be time for us to get back to the status quo in the clinic, ward, practice, dispensing counter, or operatory. Haven’t we learned anything? Are we blinded to the fiscal realities of our circumstances? Or are we, perhaps, actually satisfied with the way things are? Real change is needed, but not here, maybe over there at that other place, with them, those other people. Or, knowing that we need to change, do we know where to start? If not, we are defeated before we begin.

Just in case you don’t have a To Do List for President Obama, here is mine.

  1. Reconsider what it is we do and what outcomes are valued by those we serve – This is one of the hardest of all things to accomplish organizationally, particularly when we have been so seemingly successful. But now is the time for a quick review of core missions. Not that missions change overnight. They don’t - but we better start asking some fundamental questions about our missions. Do they direct us to provide pig liver transplants, or the most effective emergency services for the resources available? Should we offer primary care in the least expensive, most effective, and most convenient manner, no matter how much it differs from the way we currently organize primary care delivery? Do we deliver drug products in the safest, most efficient manner, even if it means doing away with the pharmacy? How about providing dental care where the epidemic of dental disease resides - in inner cities, the rural backcountry, and long-term care facilities - rather than providing it where we happened to have built the bungalow practice of our dreams? Should we really push through the integration of curricula so that students move seamlessly through our programs without the delays and obstacles created by discontinuities between schools and colleges?
  2. Reinvent or improve something small and then take it house wide – The genius and insight for reforming health care resides in the work of every professional. There will be great longing for a policy revolution or the complete correction of the financing schemes of today. We might get better policy and more aligned financing, but the fact is that change is going to come one small step at a time. Grasp something that you know needs changing. Try doing it differently. Test the new method against the prior one. Does the new method more efficiently achieve the desired outcome? Publish the results, sometimes in the most prestigious journal, more often at your work station or office door. Engage your coworkers in the hospital, office, agency or clinic about what you learned. Ask them how they would improve on it. Have them think up things they would change. Do the next test together. Share it even more widely. See how all the test outcomes align with the direction of the organization. If, considered together, the outcomes vary too much from the institution’s priorities, figure out who to talk to about this inconsistency.
  3. Build a new partnership, alliance, or collaboration – Let’s face it, health care in the US is not working for the consumer and it costs too much. Unfortunately though, health care works just fine for us insiders, so we have been the last to acknowledge the severity of the problem. We need a more accurate perspective and we don’t have time to wait for some personal epiphany to gain this perspective. It is much easier to get it by asking to share in another’s view. In the past we have paid a lot to consultants to lend us their views. They were a little conflicted as they worked for us and may not have been willing to bring a shocking message such as “your customers don’t like what you do” or “what core competencies?” Better to get someone who knows you well and can give you the advice. As with any feedback situation it will be best to do this over and over. You get better at it with practice and time. If you are really brave, here is the time to invite the consumers to the table. Don’t hide from them, make it easy for them to tell you the truth, or better yet, to take you by the hand and walk you through how they experience it. We could spend a lot of time and energy over the next decade saving the status quo for those we serve, only to discover that they really didn’t like it so much anyway. Why not take a smart step now and invite them in?
  4. Develop some new skills – Maybe you’re not ready for the bold steps above. That is OK, but it doesn’t give you a pass to sit on your hands. Instead, now is the time to sharpen up your personal leadership skills and insights. You might even need the new training if you happen to unexpectedly be on the job market soon. I would start with some self-assessment. If you haven’t done this or yours is a little out of date, it is time to reassess your strengths and weaknesses. This is not an exercise to make you feel bad. It will help you to assay your assets and gain a little insight into how you might be making problems worse. It might be good to take the small test of change skills mentioned in #2 above and try a little improvement in the old leadership reparatory. You will be amazed at the results. Some other key areas for improvement that we get requests for at The Center for the Health Professions every week are: managing conflict (go figure), developing and motivating others, aligning vision and strategy, difficult conversations, project management, and communications.
  5. Get excited about the change – This is just a little mind trick, but it is important. Health care in the US is the sixth largest economic undertaking on the face of the globe. It is really big and complex. By my back of the envelope estimate other nations, no smarter than us, deliver health care in a way that serves all of their people and they do it for fifty to seventy percent less than what we spend. Put bluntly, if we could outsource our health care to the Norwegians we would save about $650 billion a year. We might even be able to support a decent banking system with this large sum of money. A change this big is scary, but it needn’t be. Think of the opportunities and great feelings that will come when we stop defending the false prophet (or profit) and get to doing what we know is right.

[1] Daschle T. Critical: What We Can Do About the Health-Care Crisis. Thomas Dunne Books, 2008.