“Cynical people aren’t engaged in trying to make things better.”

Those the words of a leadership guru speaking on new world realities, specifically on the theme: The Cynics are Winning. While he was talking leadership, I’m talking health care.

“Cynicism is the tendency to be close-minded and disillusioned,” according to Kouzes and Posner.

The guru also cited a study that said half (that is, 50%) of the people in the United States are cynical. Well I figure that the health care industry employs over 12 million people (and growing). Mix in politicians and health care’s tendency to have issues with change generally, and I’m going to go ahead and guess that the majority of people involved with health care’s future are cynics.

There’s no other explanation for why we’ve been talking about problems in health care for 40+ years while watching safe, incremental change move along at the pace of an inchworm. And costs generally keep going up—more like the pace of a horse’s gallop.

Health care’s cynicism has got me sounding like a cynic, now. Well I’m cynical toward cynics. (I guess we can all be that way from time to time. But collective cynicism for 40+ years? Come on!)

Concierge medicine doesn’t deliver care fairly (and the current system is better at this how?). Continuity of care between PCPs and retail clinics is poor (as if all other providers communicate well?). And electronic medical records are too dangerous (the mounting number of medical errors are a fair trade off?).

Tom Peters has said, “It is an age that begs for those who break the rules, who imagine the heretofore impossible.”

There will be never be unanimous agreement on any health care innovation. There will be issues with every potential solution.

But gosh it beats inaction. It beats sticking with the same model that obviously isn’t working well. Let’s try new things. Let’s work through the problems that arise. I’m hardly arguing for tearing down what we’ve got. But don’t be afraid to experiment. Embrace experimentation.

A widely reported study has shed light on disturbing graduation rates in U.S. metropolitan cities—more than 1 million students drop out of high school each year.

The implications are scary, as Richard Florida writes, “Ponder the implications of this from everything to human development, crime, social cohesion, and economic competitiveness.”

Maybe the key to improving health in the United States is to keep those lost students in school.

Health and income are related.  As one study reports, “A doubling of income is associated with a similar effect on health, regardless of the point at which this occurs.”

Our employer-based health insurance system also makes it highly desirable to have a well-paying job with benefits.  This article reports a large gap between high school dropouts and those who graduated, “Adults who don’t finish high school in the U.S. earn 65 percent of what people who have high school degrees make.”

A healthy (and well-educated) America is a competitive America.

For whatever reason, I’ve read/heard several instances recently of people referring to the hospital and airlines/airplanes/airports/pilots metaphor.

To the best of my Google research, Donald Berwick and Lucian Leape started the trend, in an article published in 1999, by using the safety records of airlines to bring attention to high medical error rates in hospitals.

In the last few days I have seen pilot/doctor comparisons, hospital and airplane capacity comparisons related to financial issues, regulation comparisons of flying and doctoring…

Raise your hand if you have warm feelings toward airlines. Seeing none…

Type “hate airlines” into Google. Spend eight hours in airports to take a two-hour flight. Nickel-and-dime pricing. Canceled flights. Lost luggage. Waiting for hours on the runway. Some of these problems have arisen out of necessary circumstance—that isn’t the argument I want to make here. Believe me because I know, I’ve spent some time working in the airline industry.

The argument I do want to make is this: If we continue to connect hospitals with airlines to explain things, my fear is that patients are going to make the connection themselves, and I’m afraid those connections won’t always (if ever?) be positive. While the comparison may be useful, we should temper its use.

Fred Fortin at The World Health Care Blog:

With the kinds of uncertainty we are now facing in US health care — 2008 elections, unsustainable costs and a growing politics of blame and greed — the future is less about, well, the “future” and more about the present, that is our ability to simply hang on for the ride. Both the pace and unpredictability of what now confronts us makes futurists look more like shamans trying to comfort a nervous patient, than professionals who can help us line up, in some understandable order, the drivers of change.

One thing is for sure, however, any official “futures”, at least for now, are DOA. And we don’t need to pay any futurist to tell us how that story will end since the the plot has still yet to be revealed. Stay tuned.

I completely agree. And I see us continuing to operate in this uncertainty for the foreseeable future.

Earlier in his post, Mr. Fortin says that we, in health care, are very concerned with the future. And I would agree when it comes to bed capacity, workforce needs, addition of programs, or what can easily be summed up as the “normal business” planning issues.

But when it comes to sustainability as an entire health care system, the theme receives little thought, if any, when future organizational decisions are being made. And why should it? All jobs in an organization are based on that specific organization’s sustainability.  It’s the Tragedy of the Commons.  While I believe some organizations are thinking about sustainability, that conversation doesn’t go beyond community or regional borders. So the role of creating a sustainable environment for the entire health care system falls to the government.

And there’s talk of making it happen, but it’s talk. And talk at the highest level breeds inaction at lower levels. Here’s an example: with the current rhetoric of health care reform by presidential candidates, and specifically both Democrats’ plans to cut costs through proliferation of health care IT, why would any hospital, physician’s practice, clinic, etc. even consider making their records electronic at this moment? The Democratic hopefuls both have plans to help organizations pay for it. So unless the investment explicitly helps an organization reduce costs (most likely only large organizations considering the substantial cost involved) in the relative short-term, why would anyone consider it when there is the potential for the government to help pay for it?

Here’s the problem: the wait could go on forever…and doing nothing continues the cycle we’re in.

Mr. Fortin’s post was inspired by a post by Kevin Kelly in which Mr. Kelly says the future doesn’t matter anymore:

The pace of change became so fast that it outpaced contemplation. The future became harder to predict, and exhausting to keep track of. With a long, colorful history of failed predictions, it occurred to almost everyone at once that very little of what we imagined our own futures to be would really happen. So why bother?

While we often contemplate the future of our organizations, the problem is just that—because the future that truly matters is that of the sustainability of our health care system.

Serendipity is a wonderfully cool phenomenon.

On March 3rd I posted this where I posed the thought that health care problems should be solved locally.

And while I was trying to clarify my thinking on the whole matter, on March 7th the new ChangeThis Manifestos were posted and was immediately drawn to this one on “Megacommunities” by a few folks at Booz Allen Hamilton:

“Public, private, and civil leaders should confront together the problems that none can solve. Leaders everywhere no longer express as much confidence about the future as they once did. When they speak candidly, it often sounds as if they feel trapped in quicksand, unable to move forward easily. The methods and tools that helped them succeed in the past no longer work. The challenges they face—such as global competitiveness, health and environmental risks, or inadequate infrastructure—can no longer be solved by their organizations alone. And when they try to reach beyond the boundaries of their own corporation, government agency, or nongovernmental organization, there often is no clear pathway to success.”

Which led me to the book’s website.  And yesterday, the ChangeThis caretakers, had this review/information of/about the book on the 800-CEO-Read Blog.

Anyway, I’m running with this thinking.  While I’m not a big fan of the term “Megacommunities,” this concept is really powerful.  In order to compete globally, organizations, private business, and individuals will come together to solve the issues, together, at the community level (ahhh, health care!).  Working together is the only way toward true community sustainability.

While doing some Sunday reading (finals are over!) to avoid digging my car out of the 20.4 inches of snow we received in Columbus, I came across an interesting article in the New York Times on regional theater expansion.

Expansion has been on my mind lately. Evidently it’s been on theater people’s minds, too. “In recent years many of the 75 companies that form the League of Resident Theaters have looked at their aging or unaesthetic homes and joined what amounts to a nonprofit theatrical building boom. Since 2000 they and other institutions coast to coast have initiated dozens of construction projects whose combined tab is approaching $1 billion.”

Here’s the kicker, though: “What’s less evident is what it really means to operate them once they’re built.” Operating budgets doubled or nearly doubled for the new/expanded theaters. “But donors who have put their names on the cloakroom or water fountain may be tapped out when it comes time for the boring old annual fund. And annual funds are distressingly annual.”

But it’s lurch, and when one is in a lurch, one needs to find a solution.

But the companies are stuck in an economic bind. Reasonably enough, directors want the opportunity to stretch their imaginations with the latest technology, performers want dignified work conditions, and audiences want seats whose springs don’t threaten to give them tetanus. If the theaters don’t address these issues, they will stay small. If they stay small, they have to raise their prices; if they raise their prices, they risk losing new audiences; if they lose new audiences, they don’t have a future.

Change some words and all of the sudden it’s applicable:

But the hospitals are stuck in an economic bind. Reasonably enough, boards/administrators want the opportunity to stretch their imaginations with the latest technology, providers want dignified work conditions, and patients want care whose delivery components don’t threaten to give them tetanus. If the hospitals don’t address these issues, they will stay small. If they stay small, they have to raise their prices; if they raise their prices, they risk losing new patients (and old alike!); if they lose new patients, they don’t have a future.

Raising prices is easy to do.  Raising reimbursement levels is the problem and is highly unlikely in the current environment.  So what does everyone do to compensate? Increases utilization. What does increased utilization do? Moves us from spending a lot on health care to a lot more. Expansion and growth are part of business. All I’m advocating for is a little foresight.

Most of the health care (the way we know it today) consumed in the United States is delivered locally (”Mary visits her doctor at the clinic with a cough”). Some of it is delivered regionally (”Laura is delivering her baby at the regional hospital”). A little bit is delivered nationally (”Mark is going to a specialist at Mayo”).

My thought is this: if so much of health care is based locally, why are we trying to solve its problems nationally?

Massachusetts (so far), California (it got somewhat close) and a host of other states have tried to reform health insurance at the state level–and have found reform to be expensive. If anything, this has shown us that policy reform needs to happen at the national level. That’s an important first step, but any health insurance reform aimed at covering all citizens does not address the issue of rising costs.

The needs of the people in each state are different. The needs of citizens at a local and regional level are different in those states. These needs can’t be solved with an overarching national reform effort to make us all healthier. They can be solved with local leadership, with local citizens, and with local programs.

Irving Wladawsky Berger writes at AlwaysOn in a post titled (Almost) All Innovation is Local, “But often, the best new ideas are found in those areas that you know best - right around you. Global aspirations need to be grounded in local actions.”

It’s easy to share. If we make every community in this country an innovation hub, collectively dedicated to solving the many problems of health care, the problems don’t seem so numerous. It’s comparable to the idea of cloud computing, where computing resources are used collectively to solve a particular problem quickly. If ideas work, communities can copy those ideas that other communities have tried. By developing a large menu of various ways to address issues, communities can select what will work best to address a specific problem.

Some organizations around the country are already dealing with health care issues locally by finding ways to provide access to all, promoting high-quality health care, finding ways to reduce waste and thus reduce cost, and making our communities healthier by promoting healthy behaviors. Some examples: Access Health Columbus, Healthy Memphis, Healthy Wichita.

Mr. Berger concludes, “Even the most global among us still spend most of our time and energy with our families, friends and colleagues right near our homes. We get most of our nurturing and inspiration from our local base. And, . . . it is this base that then enables us to go out and properly deal with the vast global world out there.”

While the platform for change will be built nationally, the solutions should be constructed locally.

We’ve seen the lack of support in blogging in hospitals…

…but that still doesn’t (completely) explain the general neglect by hospitals of YouTube, and other online video tools.

Possibilities are endless for what hospitals and health systems could do:

1. Hospital tour - if you work in an organization where it’s easy to navigate the facilities, your patients are extremely lucky (and your organization is probably small or your leadership understands the need for navigation ease). A search of “hospital tour” on YouTube returns 582 results. Helping patients find their way around the hospital by familiarizing them with the facilities before they arrive will ease tension on what could be an emotional visit.

2. What to expect when you arrive at our facilities - when a patient arrives for a visit (giving birth, heart surgery, emergency room, etc.) confusion has the potential to reign, and a familiarity with where to park, where to go, who to seek, etc. that comes through the use of YouTube could be quite helpful.

Here’s an example from a foreign land…

  3. Get to know providers, care givers, and staff - sticking with the familiarity theme, familiar faces on a stressful day can be helpful in reducing tension. Interviews with employees and providers could help patients get to know them and humanize health care just a little more.4. Health information on popular conditions and treatments - as a community service, provide information on common diagnoses and treatments, or other public health needs/concerns.

5. Other possibilities that you may suggest in comments.

Not to mention the inherent marketing value all of these suggestions hold…

Found this post, that comes from waaay back in 2006. Over 10,000 then, about 162,000 now. On the first page, however, most videos have to do with humor, history, and (General) Hospital (the tv show), not any of the above thoughts. The idea that hospitals need to be on the offensive when it comes to online tools is an argument of note.

But if a hospital or health system really wanted to stretch its comfort zone, it would start an online “tv” network through tools like Mogolus, blogTV, and Kyte. What would you put on a live channel? Well, there are a few suggestions above, but the possibilities are surely endless.