One of the challenges in leading change is ensuring that the change itself is an improvement – not just a different approach that also generates insufficient outcomes. It is striking how often this happens. The difficulty of implementing a new approach overwhelms the participants – the loss of control and competence, severing old relationships, forming new ones – is all a bit much. In the midst of this “fog of war” – the point of the change or the measures of success get obscured.
Sometimes it is “change fatigue” (a gloomy sense we have been here before and shall return again – so why get excited?) Other times it is living in two worlds at once. A few years ago I was involved helping a large healthcare system adopt a new model of care delivery. The new model was anticipating a change in the reimbursement rules – a change we still await. The work required the system to live in two worlds simultaneously – something the financial people couldn’t stomach. The initiative was terminated. The need for the change – or its productive promise didn’t go away. It was overwhelmed by a different need and measure – quarterly results.
The irony of the tale lies in the original purpose of the change. It was felt that the change in reimbursement would have financially destroyed the system if they didn’t change. (In a nutshell – reimbursements were shifting from “fee-for-service” to a quality of care model.) Failing to shift would have been disastrous in the new world – that never came. Instead, we have continued to struggle to solve the healthcare problem in America. Costs are out of control and yet many Americans experience inadequate access or care.
Don’t get me wrong – there are as many healthcare improvement initiatives as grains of sand on the beach. Again, many of the changes haven’t been able to make things better. Obamacare lauded as a breakthrough by supporters and mocked by opponents was never the “solution.” If you recall, even the White House folks at the time referred to it as the best they could do under the circumstances. President Trump has made it his mission to overturn. Why? Probably because it bears his predecessor’s name.
But the question to ask is – will doing away with it be better or just different? The American Healthcare Act was the first attempt. Better or just different? One indication of this problem is that everyone picks their own metrics – overall costs, disproportionate expense at the end of life, covered/uncovered people. By shifting the measures we avoid making hard choices. Maybe that’s the whole point.