Make no mistake; Evolutionary leaders are hard at work in American health care. For now, however, they are unlikely to be in the news. Current hot-topic health care legislation discussions are just a symptom of a deeper, inevitable, and profound exigence for a new approach. Obamacare or no Obamacare, health care would still be in a convulsive state of transformational change.
A big part of the reason for this massive, systematic demand for change is that health care is not like other “goods and services” models that can find equilibrium in a market driven, supply and demand business model. A brilliant and readable analysis of this reality is offered by Supreme Court Justice Ginsburg in her critique of Justice Robert’s opinion at ‘The Broccoli Horrible’: Ginsburg Shreds Roberts. The gist of her argument is that people are seeking and receiving health care regardless of their insurance status or their ability to pay, and that the cost of this reality is being carried by those with insurance and/or the ability to pay.
I would hope that no one weighing in on this debate would advocate denying emergency care to those in need based on their ability to pay. It would be unthinkable to let one car crash victim bleed out at the scene because he lacked the means to pay the bill, where the other victim is cared for because he was carrying an insurance card. That said, there are some who are calling for the right to deny care to people with chronic diseases like cancer because that is simply the “American Way” (Senator Says Employers Should Be Able To Deny Coverage To Cancer Patients Because ‘Our Nation Was Based On Freedom’). My point here is not to “go political” (but boy is it easy to get sucked into the debate).
My point is that Evolutionary leaders are already at work, right now, assessing, planning, testing, and making a million little changes to our health care system. They are found in every sector of health care; research, prevention, education, public health, primary care, specialty care, emergency care, administration, insurance… You name it—Evolutionaries are tinkering with it. So why don’t we hear more about them? Why don’t we see the progress being made? There are three big reasons that have as much to do with the nature of “change leadership” in general as they do with health care in particular:
It’s Who You Know
Strategic change demands new and strong peer and partner relationships. Simply put, nothing of substance is going to happen unless you have a strong base of support and you can make connections with critical partners. If you are an emergency room doctor, you are exasperated by the kinds of situations you face day in and day out. You can optimize your ER all day long and it won’t solve the problem of HAVING to see non-emergency patients because that is their only recourse to get care. You can’t fix what is broken in your ER—because the problem is not in your ER—it’s out there—in the world that makes it make sense for a person come to a trauma center for a sore throat. If you want to fix your ER, you will have to tangle with the gnarly, nasty, complicated, and screwed up world of community health. And there are Evolutionary doctors doing just that. They are asking questions, gathering information, testing new approaches and new programs, communicating with administrators, primary care providers, payers, and even patients about the situation. They are learning and advocating; adapting and designing whole new approaches. But these are likely to be small steps; not noteworthy in and of themselves; but make no mistake they are part of a bigger design.
These Are Not the Droids You’re Looking For
At a recent round table discussion with doctors, administrators and Board members, one doctor flat out said; “If you want to make a change that influences doctors, you better figure out a way to make the doctors think the change was their idea.” Truer words have never been spoken in the world of change leadership and health care. The author Eliyahu Goldratt says, “Improvements are always a change, but changes are not always improvements.” Everybody in health care has been the victim of “flavor of the day” changes that made a bad situation much worse. So, making change happen in health care is subtle art. It requires lots of communication, input from everybody, and time to process and consider—and that is for the no-brainer good ideas. Really big changes like those implied in community prevention models and Medical Home models require layers and levels of intrigue that would be at home in a Tolstoy novel. Evolutionary leaders aren’t making news because they don’t want to make news. It does not serve their cause. They want to carefully knit together the alliances and frameworks that will allow big changes a chance to survive. Dictated, top-down changes in health care almost always wind up on the “We tried that once” heap of failures. Lasting change requires a far more ninja-like approach.
Success is Complicated; Failure is easy
An interesting characteristic of the digital age is the rise of the term “Fail” in slang. It is easy to spot failure and it is difficult to contain news of failure. Media is really good at capturing a gaff made by a politician, but it is much harder to (and probably less entertaining) to capture a powerful point of clarity. Simply put, Evolutionary leaders in health care are not in the news precisely because they are doing things right. Over the past year I have seen dozens of situations where health care professionals have done amazing things to improve patient access, improve patient safety, and develop exciting new models for community wellness and chronic disease prevention. And with very few exceptions, nobody ever hears about those efforts. There is also hard-wired humility in health care. One doctor told me, “It is hard to get excited about making a touchdown when you are still be beaten by a thousand points.” Providers need only look up from their moment of success for a second to be reminded that the platform on which they stand is completely ablaze. Evolutionary leaders are OK with the idea of making that touchdown even if they are down by a thousand points. They are OK with small victories, and they believe in the power of incremental success and momentum. They are crazy optimistic and they recognize that they will likely never achieve success in their lifetimes, but they love the fact that they set the stage for success for the next generation.
If you are on a hunt for incredible Evolutionary leaders; stop by your local hospital or physicians group. Talk to nurses, dentists, and insurance people. They are there. They are very busy. They are making lasting changes; building new partnerships, socializing changes, and winning one step at a time.
Stay tuned for an upcoming podcast I made with Dr. Brigitte Piniewski, a real health care Evolutionary.