The fundamental Challenge of Healthcare Reform

Imagine that you, a non-physician, were given a white coat and told to diagnose and subsequently treat a patient who was close to death. That analogy is similar to physicians who almost universally have no formal or practical experience to lead and implement massive change. It is actually worse than that.

Now imagine that you are an accomplished tennis player. The road hasn’t been easy. There were countless hours of practice, tournaments, and individual coaching. You learned the rules and decorum which everyone agrees and adheres to. Then one day you are selected to be on the soccer team of a foreign country. No longer is success based solely on your individual performance or capabilities. This is truly a team sport. There are new rules, language, and skills which are generally followed. In some countries when the fans are unhappy with the result they are not only rude, but sometimes come out to the field ready to do battle.

This describes the transition faced by many healthcare leaders. They are all individually accomplished and have received recognition and often their leadership posts because of their technical capacities. But the game, language, rules, and the nature of the interaction with the players have changed. BUT TYPICALLY NOT THE SKILLSET OF THE PHYSICIAN LEADERS!

Already overworked, less appreciated by their professional peers, and overwhelmed by the task in front of them, physician leaders on the front line juggle the challenge of meeting the requirements of the current game, treating patients and meeting the financial objectives, and build the capacity to play in a new, yet undefined game. Once exception: The rules of soccer have been defined. The rules of engagement and winning are clear.

The sparse data suggest that the majority of new programs of new projects are unsuccessful. More than 60% of healthcare balanced scorecard initiatives fail. Similar results are experienced with LEAN implementation.

Fundamental healthcare strategies

What is missing is a platform for change. Here are several elements that are almost universally needed.

1. Establish clear organization objectives. Although the healthcare policy is far from settled, we know that the new models of care require

• Higher levels of collaboration and openness for new possibilities
• Greater emphasis on the use of data in decision making and evaluation
• Greater emphasis on core organization competencies
• Higher levels of partnership between healthcare related entities
• Greater use of technology
• Higher levels of employee engagement

2. Develop more highly skilled leadership at all levels to plan and execute the work require the ability to

• Juggle the realities of the current world while building a new one
• Work in highly ambiguous, often contentious situations
• Develop common ground with essential stakeholders who have competing agendas
• Engage fellow physicians and staff who are disillusioned and burnt out by the current system

3. Redistribute work

• Create high performing teams of care
• Re-allocate work so that physicians focus on those areas that require the greatest skill and payback
• Build the capacity of people to work together in team environments

These three capacities represent the essential building blocks for healthcare reform…regardless of policy specifics. They are all within the purview of existing organizations to accomplish. They require only the resolve of senior leadership to put them into place. Those organizations that possess these three capacities are far more likely to be able to adapt to an uncertain future.