Writers who study change and improvement make a number of observations that I find congruent. Why does this interest me? Because health care systems have to transform, and it is very likely for many that transformation will be too little too late.
The reason is that is transformation requires giving up a lot for a future that can be very uncertain. So to give up something, we have to see a result that’s worth it. In health care, we have to give up a lot, and the cultural, organizational, and personal inertia being attached to the past is powerful.
To those who think we can just put our heads down and wait this out,
I really have to say “you’re in for a lot of pain.”
In my own organization, I repeatedly hear that health care reform efforts, legislation, payment changes, and the like are all a passing phenomenon. If we ignore it, just like managed care in the 90s, it will go away and we can continue our old ways. The other common theme in my conversations is “okay, I can feel and I understand that we have to change because this is not working… But what do I do? What does it look like when it’s changed?”
To those who think we can just put our heads down and wait this out, I really have to say “you’re in for a lot of pain.” The forces requiring health care to become a better value are too powerful, and are independent of political view, or one’s assessment of the value of regulation versus market competition. Our society cannot afford the current cost of health care in the United States. It is sucking the life out of the middle class. It is impairing business competitiveness. It’s pulling resources away from education, the environment, and even retirement funding. In the United States, the middle class has had no increase in net income over the past decade, despite modest improvements in total pay.
That’s because all of their improvements in total pay have been consumed by their component of health insurance costs in our employer-based model. So whether it’s through market competition, or regulation, those who do not provide value in health care will fail. And those who make the early changes necessary to provide great outcomes and patient experience at an affordable cost will attract healthcare consumers away from those who do not. Medical practices will fail, hospitals will close, and successful systems will consolidate and grow.
So if the status quo is intolerable, and doomed to fail, what has to happen to change? The business literature, and those who spend their careers studying change, suggests that successful companies like so many health care organizations right now usually wait too long and fail because disruptive innovation “eats their lunch.”
Clayton Christiansen, author of The Innovator’s Dilemma, has studied numerous organizations that failed, and those that succeeded in disrupting and growing. Just as the modern view of quality improvement in health care argues that bad outcomes are usually due to good people in dysfunctional systems, Christiansen argues that these companies that fail are not because of stupid managers grown too cautious or complacent to change. After studying these companies, he concluded that the only way a big company could avoid being disrupted was to set up a small spinoff company that would function as a startup, make a new low-end product, and be independent enough to ignore what counted as sensible for the larger organization.
Others who study transformations of organizations, like Edgar Schein, note that the vision of what’s possible is needed before people can give up old ways. And getting to that vision requires transformation of the culture and subcultures, because “the way we do around here” cannot survive the need for change.
To get to a changed future also requires a change in leadership and management. Douglas MacGregor calls this the shift from management theory X (that people are basically lazy, and must be motivated and controlled) to theory Y (people are basically self-motivated and can be channeled and challenged).
So what could we look like that would ‘unfreeze’ our current culture and trajectory, and allow all of us to tolerate the anxiety created by giving up what we have?
I can see Cooley Dickinson as the most successful community health system in New England based on customer experience and outcomes, at competitive cost. We will achieve what matters to our customers as determined by them, with the highest possible quality of care goals set in partnership with our parent organization, Massachusetts General Hospital. We will accept responsibility to achieve these outcomes with our regional resources and partners or commit to finding the resources our communities need outside our service area. We intend to provide our communities with what they need, when they need it, and in the best setting available. We have the resources to do this, either within our organization or available from local partners and Mass General. I can see extraordinary coordination of care, outstanding access, and innovation in care delivery models supported by a physician organization with a partner hospital and the VNA & Hospice of Cooley Dickinson.
Hang on, it’s already a wild ride, but it’s worth it.