Business Matters
From Ellington to EinsteinLeaders have the courage to ask why—and why not—and then to act
After decades of effort by hospital leaders to ensure access to care, we are on the brink of momentous change. When the dust settles in Washington, however, we will find that our roles have also begun to shift. These changes will be disruptive and threatening—and they will offer tremendous opportunities.
I was privileged to serve on the AHA Board of Trustees for five years, and came to know hospital and health system leaders who pioneered innovations that are now debated as "new" strategies for health reform. Rich Umbdenstock was part of founding what is still one of the most impressive communitywide health data exchange and services organization in the country in Spokane, Wash. George Lynn founded a community health information network 25 years ago. Innovations sponsored by Tom Priselac at Cedars-Sinai evolved into an entire company devoted to applying care guidelines and benchmarking clinical results in hospitals.
A job description for the leaders capable of carrying us through the next wave of changes would include skills, intellect, understanding of the complexities of health care and fortitude. But above all, we need two characteristics: inquisitiveness and courage.
"Why" is a powerful word. Hospital leaders should relentlessly inquire why we do what we shouldn't, why we don't do what we should, and how we can discover better, cheaper, more satisfactory ways of providing care and running our enterprises. We have a very special dispensation in health care: We are allowed to explore, test and discover new knowledge, as scientists and humanitarians. We are supposed to question. As Einstein said, "If we knew what we were doing, it wouldn't be called research, would it?"
Discovery is its own kind of pleasure. Working hard on important problems is a joy. Duke Ellington said his "biggest kick in music—playing or writing—is when I have a problem. Without a problem to solve, how much interest do you take in anything?"
Inquisitiveness can mean not only why, but also why not. If we know certain changes can save lives and dollars, why do we not undertake them? This kind of inquisitiveness has led to impressive leaps forward. The 100,000 Lives Campaign galvanized thousands of hospitals to change core work processes and literally save lives.
The second characteristic we need is what philosophers call "moral courage." It's harder to marshal than bravery under fire. Eddie Rickenbacker pondered why "physical courage is so common in the world, and moral courage so rare." In health care, courage will be needed to press forward with clinical improvements in the face of overwhelmingly complex and perverse financial incentives.
Change that is big enough and important enough to matter is disruptive. It threatens long-standing relationships and processes. Hoping for change without being willing to confront disruption is futile—equivalent to wanting "crops without plowing up the ground" or "rain without thunder and lightning." That's Frederick Douglass, and like Einstein, Ellington and Rickenbacker, he has a consistent message for us: Do what is right, what moves our mission forward, and what—because of its ambition, courage and potential—is really worth the disruption.
Molly Joel Coye, M.D., is CEO of the Health Technology Center in San Francisco. You can contact our guest author at mcoye@healthtech.com.
This article 1st appeared in the November 2009 issue of HHN Magazine.
To respond to this article, please click here.
