Influencing Change

The creaking sound that you are hearing is the ice beginning to break up in the overly ossified structures of what has for many years passed as a “system” of health care in the US. While the policies and regulations are yet to be fully in place and a few courts and a majority in the House of Representatives are calling for its demise, the organizations, institutions, professions, practices, companies and agencies that form our crazy quilt arrangements for care are beginning to imagine what a more integrated, more consumer responsive, more value added approach to health care might look like.

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New Year’s Resolution

Most of us cannot resist the temptation of new year's resolutions this time of year but, in health care, the needed change will be tricky. The opportunities we have been presented by the crisis in health care costs and the framework of reform do not need new commitments to work harder, longer or even better. The major challenge we face today and for the next few years is how to work differently.

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Community Based Responses to Health Care Reform

Across the nation different parts of the health care system are scrambling to figure out how they will respond and fit into a reformed approach to health care. Hospitals, professional practices, clinics, safety net institutions, health plans, schools and colleges see the parameters of the policy change, feel the movement of the market and are beginning to realize that they need to reposition their vision and strategic business objectives to align with these forces. While these institutional and organizational responses are to be expected and are needed to give shape and definition to the broad principles set out in the legislation, they generally fail to rise to another level of consideration for integration and improvement.

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Health Care Reform and American Exceptionalism

The concept of American exceptionalism, the notion that a distinctive set of values and practices have served the nation well for over 200 hundred years, is a powerful part of our success as a nation and a people, is a deep-seated part of our culture and curiously has appeal to both sides of the political aisle. However, the parties’ ideologues do see the pathway to enhancing that exceptionalism in very different ways. This broad cultural characteristic is a composite of many different and sometimes even conflicting qualities. It includes individual responsibility, entrepreneurship, community action, innovation, pragmaticism, compromise, diversity, and a trust in the wisdom of the common citizen. There is not much in our cultural past, the rhetoric of current politics or our aspirations for the future that do not play on the belief set that makes up American exceptionalism. And these values and abilities are essential to making the health care reform come to meaningful life over the next decade.

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Making the Case for a Change

As the reality of health care reform begins to sink in and the various elements of the new laws go into effect, health leaders across the nation and in every conceivable health related enterprise are beginning to ask where they can get the direction they need to respond to the opportunity that we have been told is once in a lifetime. From community clinics to professional groups, to health plans, to hospitals, and across the various clinical and non-clinical professions, everyone seems to be looking for the operating manual. It is not there. Jokingly, I posed this point in a talk last week, and in an off-handed way indicated that I had found the instructions for implementation on page 256 of the Patient Protection and Affordable Care Act. I was not encouraged when about 15% of the audience took the time to write this down.

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Leading the Sacrifice

One of the most important responsibilities of any leader in any organization and any place within that organization is seeing and advocating for the larger interests. I realize that such a view might be seen by some as an outdated collectivist perspective, but I believe that every successful individual, team and organization has as a fundamental part of its make-up the ability to sacrifice for the greater good; the well being of the whole. In fact, if such sacrifices are not made and they do not lead to enhanced success, then what possible value could we derive from associative action? Over the years I have asked the same question to hundreds of teams in development workshops: What were the key elements of your most successful team experience? I hear lots of qualities, but I never fail to hear individual sacrifice as one of the efforts that is essential for teams to work.

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Alliance Strategies for Accountable Care

The competencies I proposed last month as important considerations for beginning the work of remaking the US health care system met with a great deal of positive reaction. Many responders asked that I expand a bit on the idea of developing and managing partnerships, alliances and acquisitions across organizational and sector boundaries. As the system of care moves toward the creation of Accountable Care Organizations, such work will become increasingly important. If you are a leader who is engaged in broadening the work of your organization or you are just beginning to recognize the need, here are five steps to consider as you develop your leadership strategies.

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Competencies for a Reformed Health Care Environment

Last month I raised a few questions about team competencies in a reforming health care system. I heard from several readers asking for a more general set of leadership competencies that this same environment would likely demand. Here are five general leadership skills that will need to be particularly refined, if health care institutions, practices, and professions are going to adequately meet the demands of a rapidly changing health care world. 

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Health Commons: The Courage to Remake

As I write this month’s installment of “As Health Care Turns,” I count six states’ Attorney Generals who are threatening or preparing to sue the federal government on behalf of their citizens over the Health Security Act. This strikes me as more partisan politics than good policy, not because these acts conflict with my political views, they do, but because Ronald Reagan’s Solicitor General, the imminent Harvard Law School faculty member Charles Fried, has called such attempts “frivolous.” This is not to say the law is perfect; it isn’t. But it is a beginning and a framework for us to engage in the serious work of remaking health care in America. If we don’t take this opportunity seriously and roll up our collective sleeves, our children will pay for our shortsightedness throughout their lives.

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