With the presidential and congressional elections in the rear-view mirror, there is significant speculation about how health care policy will change in the coming years. While the nature of that change is uncertain, one undeniable fact is that—in addition to policy changes—much of the change in the way health care is paid for and delivered in the coming years will come from front–line organizations where patients receive clinical care. However, there is general consensus that the pace of change in these environments is slow and that “it’s challenging to progress ideas.”
Why is that?
Problem # 1 – We must redefine what leadership looks like in healthcare
Too often, those of us involved in leading health care organizations socialize the idea that leadership is necessarily slow, painful, incremental, and political. Leaders that rock the boat may be perceived as threatening, whereas those who preserve the status quo are often welcomed as calm and effective. We implicitly—and sometimes even explicitly—value those who protect and preserve over those who push and drive. There are countless examples of health care leaders across the country whose zeal for transformation led to their dismissal or removal in favor of more “stable” leadership. While many of these leaders find success working within smaller organizations and startup companies—more traditional, larger healthcare organizations must find a way to work with leaders whose drive for change can be a catalyst for necessary progress.
Problem # 2 – We must quicken the pace of change in healthcare
Somewhere along the way, it became acceptable in healthcare to have change management timelines that stretch from days, to weeks, to months, to years for things we already know work. When I was a research fellow at a business school, I wrote a case study on a Midwest hospital system that had become famous for implementing open-access scheduling in its clinics and multidisciplinary team-based rounding in its inpatient wards. When I visited the system, I was surprised to learn that the scheduling model was limited to one clinic; and the rounding model was limited to only one ward. We need to get out of the mindset that incremental is okay—and that slow is necessarily the pace of change.
At CareMore, the integrated payer and delivery system I lead, we often reject the need for pilots to validate ideas that have been effectively implemented elsewhere—and bias towards considering how these interventions can be introduced at scale at the outset.
Problem # 3 – We value process over outcomes
We’ve all had experiences where we believed we were doing the right thing, only to have someone slap our hands because we didn’t talk to the right person before we did it. If that happens enough, front-line leaders stop caring. They start perceiving that it’s not worth trying to make a difference. Even worse, we start thinking that the means are more important than the end. Change happens in cultures that value it.
At CareMore, physician and business leaders are encouraged to improve processes on their own, without centralized management control or permission. While this produces some variation across our system—this variation is the lifeblood for innovations that can then be diffused more widely.
Problem # 4 – We fail to make the hard decisions
We don’t say “no,” disagree, or aggressively manage performance nearly enough. Thankfully, healthcare attracts nice and caring individuals. But being a nice person doesn’t necessarily equip you with the confidence or willingness to make the difficult decisions required to manage change and transformation in a complex industry. It is impossible to get things done—or move things forward—when we are culturally unable to discuss truth and manage to truth.
Problem # 5 – We shroud ourselves in jargon
We hide ourselves in jargon—“innovation,” “lean,” etc. Plain speak has become a foreign language in health care. And rather than creating and reinforcing common language, common meaning, and common purpose, we have created divisions between those who speak the rarefied jargon of health care improvement and those who do not. There is even division among those who speak the same jargon, but ascribe different meanings to a particular work or phrase, such that a leader things that he is saying one thing but his staff (or other stakeholders) are hearing something else. Unfortunately, those who do not understand—those who might otherwise be advocates for change and reform—sometimes stand as the biggest obstacles, the largest stumbling blocks; when, if the idea was described plainly, all might be in agreement. We must create a common language of health systems change and improvement that is simple and accessible to all.
I remember explaining the concept of the Plan-Do-Study-Act rapid process improvement cycle to a physician-scientist. After explaining to him, he turned to me and asked, “Isn’t that just the scientific method applied to improving operations?” It dawned on me that while the language of a “Plan-Do-Study-Act” cycle was helpful to those who lived within the world of healthcare improvement science, it was locking others—like my physician-scientist friend—out, and didn’t need to.
A path forward
Although commonplace, these problems are not intractable. Changing the culture of healthcare organizations to be more supportive and amenable to change will be critical. I believe there are several ways in which health care leaders can quicken the pace of change and dispel the notion that “it’s hard to progress ideas in healthcare.”
To start, we must not lose the forest for the trees. An unfortunate, near-term focus on minutiae can distract organizations from their larger purpose and goals. Many healthcare organizations and leadership teams periodically take a step back to refocus themselves on their mission, vision, and values. I don’t think you can do this enough—particularly in a time of great transformation for the industry.
Leaders of organizations with a reputation for significant clinical innovation like the Mayo Clinic and the Cleveland Clinic frequently hearken back to the initial vision of their founders—as a way of creating alignment across their organization. Doing so can be grounding for teams whose natural tendencies might be to get lost in secondary details. Reminding teams why they do what they do and creating an ethical obligation to fix systems, to ask bigger questions, and to drive progress helps maintain momentum for change.
In addition, health care organizations need to be able to speak plainly about problems—and “call their babies ugly” from time to time. Organizations need to embrace conflict as a means of generating forward motion. Health care organizations must get beyond marketing speak and address the obstacles that stand in the way of accomplishing things for patients that they know to be right. We must be who we say we are, do what we say we will, and accept nothing less—recognizing authenticity as a core leadership value. We need to start having real conversations about why things are—or aren’t—happening, and address barriers head-on. If leaders can start to do this, we might just force the hard decisions that we somehow never otherwise seem to make, especially those around performance management.
At CareMore we speak frequently about the importance of being CareMore 100% of the time; and closing the gap between who we say we are –and who we are. This cultural acceptance that we have room to improve has helped to accelerate efforts to improve our service delivery to the patients we serve.
The year 2017 will be defined by a change in the direction of health care policy. One way that we can continue to make progress even as the policy environment evolves is to refocus ourselves on health care organizations as a center for meaningful change. That change will only be meaningful if we can address the cultural barriers to “getting things done” and build leadership and organizational cultures that bias towards action.