I had breakfast with a very wise (but not old) colleague yesterday who shared her belief that we need a new brand of leadership to right this ship and move it to the next level. No, I am not talking about Washington DC (no matter how relevant that might be), I am referring to our healthcare leadership.
We have wonderful leaders and managers in healthcare - especially hospitals and especially hospitals with adequate resources. They manage their bounty well and create additional income. That is what we have always wanted of healthcare management and that is how we have measured them.
Unfortunately, we are at a crossroads where that is no longer enough...not that creating a surplus and adding value isn't enough, but at this juncture, it is not what it will take to succeed.
What will it take to lead in the years 2012-2020? First, I believe it will take profound creativity and vision - to step back from the success of the past and to look at it under a very powerful microscope. In doing so, some of those metrics might not lead to where we need to be. Secondly, it will take single-minded dedication to a change in course, no matter what the intermittent stumbling blocks and short term losses are. Third, it will demand more participative, cooperative relationships - driven not by what the institutional needs are but what the patient and providers will need to be more efficient. That third point, requires a suspension of ego and status, an ability to bury the images and baggage of the past to define a new system. Fourth, it requires system thinking. Each process in the system needs to be able to communicate and mesh with other processes but they need to be clear and safe. Which means complexity needs to be routed out of the system instead of embedded in it. Fifth, it requires absolute transparency. A problem is a problem and a solution is only a solution if it drives to the outcome intended.
Do we have leadership like this in healthcare?. Absolutely. Is it universal? Not even close. What we used to say about raising kids is that they are the most dangerous when they don't know what they don't know. I think we are right at that point. A lot of teenagers who know they know ---but just maybe we don't see what we need to see to move forward. It is going to take some growing up (and I don't mean eat your peas) to hear what patients and doctors and nurses have been saying all along. The system is broken in that it delivers excellent care but not excellent outcomes. At this cost, we will need to look more closely and listen very carefully to identify what the population we serve needs to stay out of our institutions.
How do you embrace change if you can't see it? I have always believed that there are two drivers: cost and patients. If you want to lessen your own cost in your own institution, forget it. All you do is trim the edges. If you want to reduce or bend the cost curve, then you can begin to see the changes. You can see that it is not this one patient's stay but maybe a whole category of the most expensive medicare patients that all have 4 or 5 variables
