@CherClarHealth, aka Cheryl Clark, reports some important comments by Don Berwick in an interview published this week in HealthLeaders Media. An excerpt:
[T]here is a gap between the improvement movement on the one hand, which has a lot of knowledge about using improvement to achieve cost reduction, and the responsible public policymakers and public servants who formulate regulations and laws.
And I have to say the same gap often exists between the improvement movement and the C-suite in medical organizations, hospitals and large systems. There is too much distance between the front office and the front line, and so executives can fail to appreciate quality as a business strategy, just as policy makers can fail to appreciate quality as a public policy strategy.
I feel like Don and I are like a sine function and a cosine function, moving along with the same periodicity, but slightly out of phase. He notes:
I came out of the improvement movement. That's my original knowledge base; but I and many others are learning how to bring our knowledge into the political arena. That bridge needs to be built.
In contrast, most of my previous experience comes out of the political arena, running state agencies in Massachusetts and Arkansas. My stint in health care came along later. With help from Don and his colleagues and other really great people around the world, I learned a bit about patient care. But the way I applied it in the hospital setting was based on principles of negotiation and constituency building that have their roots in political theory and community organizing.
The main thing that I learned in the political environment is that top-down thinking does not work when you are trying to create a coalition or build a movement for change. I also learned that financial incentives and penalties are not motivational, and that they are crude tools often accompanied by unintended consequences. A good leader trusts in people's good intentions--their desire to do well and to do good--and understands that their underlying values can provide the foundation for transformational change.
The article concludes with this statement by Don:
You didn't ask me the optimist or pessimist question. The answer is, I'm an optimist. I like what I'm seeing at the local community level. And the next couple of years, the story of healthcare in America may be told community by community rather than from inside the Washington beltway.
Again, he and I are out of phase, but I am hoping he is right. I am not yet an optimist. I, too, see some wonderful things going on in some communities. But I don't see leadership, and I don't yet see a movement. The major question I get as I travel is, "How can I get my CEO (or my department head) to reduce 'the distance between the front office and the front line?' I still see many, many CEOs, chiefs of service, and boards of trustees who have yet 'to appreciate quality as a business strategy.' Their minds are elsewhere. In my view, hope lies in three possible vectors for change:
1) Small groups of like-minded people in organizations who get together and experiment with small, incremental improvements and prove the case to themselves and, gradually, to those in the upper echelons;
2) The coming generation of medical students and residents, who are fascinated and passionate about employing the scientific method in clinical process improvement and who believe in using transparency to hold themselves accountable to the standard of care they have chosen;
3) A budding patient advocacy movement, people like e-Patient Dave, Patty Skolnik, Helen Haskell, Linda Kenney and others who have experienced fear, pain, and/or tragedy and who persistently demand to be let in and be partners in the design and delivery of care.
Don is correct to point out that there are more examples than ever of movement, success, and excitement in community settings. He's been at this a lot longer than I and so likely has a wiser perspective. The "sine-cosine" phase difference between his optimism and my reluctance to be optimistic just yet is that I have seen the power and speed with which other political movements have emerged. In my view, this one is still a bit pokey. I'd like to see more acceleration.
[T]here is a gap between the improvement movement on the one hand, which has a lot of knowledge about using improvement to achieve cost reduction, and the responsible public policymakers and public servants who formulate regulations and laws.
And I have to say the same gap often exists between the improvement movement and the C-suite in medical organizations, hospitals and large systems. There is too much distance between the front office and the front line, and so executives can fail to appreciate quality as a business strategy, just as policy makers can fail to appreciate quality as a public policy strategy.
I came out of the improvement movement. That's my original knowledge base; but I and many others are learning how to bring our knowledge into the political arena. That bridge needs to be built.
In contrast, most of my previous experience comes out of the political arena, running state agencies in Massachusetts and Arkansas. My stint in health care came along later. With help from Don and his colleagues and other really great people around the world, I learned a bit about patient care. But the way I applied it in the hospital setting was based on principles of negotiation and constituency building that have their roots in political theory and community organizing.
The main thing that I learned in the political environment is that top-down thinking does not work when you are trying to create a coalition or build a movement for change. I also learned that financial incentives and penalties are not motivational, and that they are crude tools often accompanied by unintended consequences. A good leader trusts in people's good intentions--their desire to do well and to do good--and understands that their underlying values can provide the foundation for transformational change.
The article concludes with this statement by Don:
You didn't ask me the optimist or pessimist question. The answer is, I'm an optimist. I like what I'm seeing at the local community level. And the next couple of years, the story of healthcare in America may be told community by community rather than from inside the Washington beltway.
Again, he and I are out of phase, but I am hoping he is right. I am not yet an optimist. I, too, see some wonderful things going on in some communities. But I don't see leadership, and I don't yet see a movement. The major question I get as I travel is, "How can I get my CEO (or my department head) to reduce 'the distance between the front office and the front line?' I still see many, many CEOs, chiefs of service, and boards of trustees who have yet 'to appreciate quality as a business strategy.' Their minds are elsewhere. In my view, hope lies in three possible vectors for change:
1) Small groups of like-minded people in organizations who get together and experiment with small, incremental improvements and prove the case to themselves and, gradually, to those in the upper echelons;
2) The coming generation of medical students and residents, who are fascinated and passionate about employing the scientific method in clinical process improvement and who believe in using transparency to hold themselves accountable to the standard of care they have chosen;
3) A budding patient advocacy movement, people like e-Patient Dave, Patty Skolnik, Helen Haskell, Linda Kenney and others who have experienced fear, pain, and/or tragedy and who persistently demand to be let in and be partners in the design and delivery of care.
Don is correct to point out that there are more examples than ever of movement, success, and excitement in community settings. He's been at this a lot longer than I and so likely has a wiser perspective. The "sine-cosine" phase difference between his optimism and my reluctance to be optimistic just yet is that I have seen the power and speed with which other political movements have emerged. In my view, this one is still a bit pokey. I'd like to see more acceleration.