Adaptive Strategies Blog

Concepts help active critical thinkers organize their thinking. Sometimes the simplest of concepts work the best.

Reflect on the reality of workers in the healthcare system. I don’t care who you think about – it could be a doctor, a nurse, a technician, or an administrator. These workers are talented and dedicated and eager to do the right thing (most of the time). However, they “live” in the smallest box of a series of nested boxes.

It would be wonderful if the boxes fit in perfect alignment. However, the reality is more like:

Leaders at all levels in the system should be searching for answers to the following questions:

• How will the economy (and its slow recovery) affect the healthcare industry?
• How will your company respond to changes in the industry?
• How will jobs have to change to respond to changes in company strategy?
• Will the leaders and the workers have the skills needed for the job changes?

Most of the workers “in the trenches” simply want to do a good job, feel satisfaction, and have security. It’s up to the leaders in the government, the industry, the hospitals, the companies, etc. to make sure the people actually doing the work know why their jobs have to change.

Think about the turmoil surrounding healthcare; think about nested boxes. This is “creative destruction” at work and the system WILL (eventually) realign itself. What “pinch points” can you forecast as we reflect on the reality of changes to the system? What

Great thinking is built on great questions. Unfortunately, it seems to me, we have started with answers before we agreed on the important questions.

One of my favorite books is Asking the Right Questions: a Guide to Critical Thinking by Browne and Keeley. Let’s see how a few of their questions help inform the discussion about health care

• What are the issues and the conclusions?
  • Let’s stick with the issues from the last post: coverage, quality, cost, and choice. We are still wrestling with the conclusions about each of these issues. Coverage seems to be the big Democratic issue and a conclusion for many is that coverage needs to be universal. Cost and choice seem to be the big issues for the Republicans and tentative conclusions are that cost will be too high and that choice is important and will be hurt by a “government” agency.
  • Bring this down a notch and look at it from the perspective of a hospital executive: universal coverage is good; high quality is demanded; cost should “reasonable;” and choice may be bad if it adds to administrative costs.
• What words or phrases are not clear?
  • Do we have common understanding of: “rationing,” “free market,” “recission,” “Obamacare,” “level playing field,” “socialism,” or, for that matter, “health.” Think back to the days of the “quality” movement – lots of discussion by what we meant by quality.
• What are the value conflicts and assumptions?
  • Is the healthcare system run as a “zero sum” game. Does one party win at the expense of the other? Unfortunately all of the public “debate” has focused on differences and not common ground.
  • What line items should be used in a healthcare system report card? Until we have a common set of items we can cherry pick “the best system” to fit our needs.
  • There are a bunch of assumptions that have to be investigated: Will quality reduce cost (like it did for manufacturing)?
• How good is the evidence?
  • There are bits and pieces of evidence floating around, but little has been used in coming to terms with the debate.  Furthermore, when numbers are presented they are not always put in proper context nor made widely available.
  • What evidence would you want to see to come to grips with the issues of coverage, quality, cost and choice?
• Are the statistics deceptive?
  • The short answer is Yes. We have to make sure we understand the basis behind the numbers.

We have a lot of very smart people who can find answers once we have posed the right questions. From your point of view, what are important questions that no one seems to answer?

The foundation to good critical thinking is coming to grips with the issue at hand. Saying that “the system is broke” is meaningless until you define system and all of its components. To rail against “Obamacare” is meaningless unless you can explain what you mean by Obamacare. So, what’s the issue?

I’ve been reading T.R. Reid’s excellent overview of healthcare, The Healing of America, wherein he compares healthcare in Germany, France, Japan, the U.K., Canada, and the United States and his framework is very instructive for considering “the issue” about healthcare. His framework is composed of four factors: coverage, quality, cost, and choice. With just these four words, you can start to better define some of the many issues.

• For the 30 to 45 million uninsured, it really is all about coverage. However, for the business owner coverage means added cost.
• For the well-to-do, or the retired person pondering Medicare Part D, it may be about choice so as to maximize benefits. However, for the insurance company with a near lock on a state, choice is the last thing they want.
• I want to know exactly how much an operation is going to cost, but my doctor has no way of knowing until after the fact!
• All of us want “the best” but someone (“not me”) has to pay for it.
• And on, and on, and on.

And here is the nasty part of trying to define “the issue.” We can be pretty sure that some blend of the four factors is going to change. We just don’t know what the blend will be.  So what is a healthcare executive to do? As I said in response to an earlier post comment, the answer is not to stand still and react after-the-fact.

Whether you are a hospital exec, an insurance exec, a doctor, an employer, a supplier or an individual the issues are explored and defined by knowing what is in your control and what is not and then determining what it will take to remain viable as the system changes. Here are some hypothetical responses to possible futures of healthcare. Consider the plight of a hospital exec if…….

• Universal coverage is enacted – How much will ER capacity and staffing go down if patients see docs earlier?
• Electronic medical records are legislated to improve quality – How many older docs will take retirement rather than make the change?
• Patients can choose from hundreds of insurance funds – How many billing clerks will have to be added unless standardized forms are used.

You get the picture. We know the system will change. We don’t exactly know what will change. It’s a human tendency to wait – but that may be too late.

OK, I’m not foolish enough to think that healthcare executives are reading this blog. So let’s make it personal. MY issue with healthcare is simple – since my wife and I are on an individual policy and can be dropped or priced-out if either of us dare to get too sick, our actions are to exercise and eat healthy and hope Medicare is there in a couple of years. It’s my responsibility to stay out of the system, because I know I can’t afford to get sick. Depressing, but true.

See if you can define YOUR issue with healthcare. They say that all politics are local, and nothing gets more “local” than health. Consider Reid’s factors of coverage, quality, cost and choice.