Author and entrepreneur Kent Healy invites us to picture two people walking down a bustling New York sidewalk. One looks up — taking in the skyscrapers, clouds and window reflections. The other looks down at the concrete sidewalk and blacktop of a busy road. Although they are in the same environment, their impression and interpretation of the city is entirely different.


Our minds are like these pedestrians, taking in and filtering information about the world around us. There is no universal interpretation of reality, writes Healy on his blog, Instead, the difference between success and failure, opportunity and constraint, is the vantage point and belief set from which anything is viewed.

Our assumptions and conclusions are relative to our position — physically, mentally and emotionally. We filter out information that is not reflective and supportive of our current beliefs. Thus, the difference between success and failure, happiness and sadness, optimism and pessimism, opportunity and constraint, and so on, is not the world itself, but the vantage point from which it is viewed. Only we can choose to look up or look down.

Seeking a New Perspective

For health care executives, this is a relevant message in uncertain times. Our perspective guides where we find opportunities, how we measure success, how we work with health plans, how we reward our employees, and how we treat our patients and serve our communities.

Today, we can choose to stick with the older narrow view of health care, or we can expand into a panoramic view of our environment and the needs of the people we serve.

The old, narrow view sees health care as local only. We focus on our facilities — or even individual clinics — thinking about optimizing health care delivery, getting paid in a fee-for-service model and performing episodic and à la carte medicine. In this view, we deliver the most intensive care and largest number of services we can, regardless of cost or even a rational view of efficacy.

The new, panoramic view is born of health care reform and the growing need to provide greater value for our society’s health dollars. In it, we view our hospital within the larger social, political, cultural and economic context and as just one part of the medical neighborhood. Our focus is on person-centered, holistic care. We deliver affordable, effective, sustainable care with an eye to maintaining wellness, not treating illness.

Seizing the Opportunity

Surprisingly, the panoramic view brings us tremendous opportunity. When we see our broader environment in a social, political, cultural and economic context, we are able to respond to the needs of the people we serve in a personal yet broad context of public health. We can view person-centered care as an entire process, from cyberspace to home to community-based centers to institutional care and health maintenance. We will be able to develop new models of delivering services and improving effectiveness through partnerships with others who share our values.

"Mavericks understand that all success begins as a mindset, not a skill set," writes Healy. They know that how they construct the world around them will determine what they see, do and feel.

In this era of declining reimbursement and tremendous change, health care mavericks who adopt a broader mindset — a panoramic view — will be rewarded, while providing value to patients by caring for them in a profoundly new way.

Adopting a Panoramic View

There are many things that we can do to adopt a broader view and transform our hospital-centric organizations into accountable health networks. Adopting a new paradigm might include answering the following questions:

Understanding customer requirements. This may sound simple, but do we really know who all the customers are in our value chain and what they think about us, as well as what opportunities might exist for new working relationships? Do we speak with employers to understand their concerns about access, quality and cost? Do we speak with payers and third-party administrators on a regular basis to share strategies and concerns outside of contract re-negotiations? Is there an opportunity to pilot new approaches to bundled payment, pay at risk for quality outcomes, and so forth? Do we collaborate with independent physician organizations that are contracting directly with payers to establish joint approaches to clinical integration?

Forging a new mission, vision and strategies. Have we looked at our mission and vision statements lately? Do they speak to a new direction of aligning with clinicians to take responsibility for the health of a population? Have we defined our strategies for growth through partnerships with others across the health continuum? The discussion and engagement of our mission, vision and strategies is critical to setting a new direction.

Building new organizational structures. Have we considered restructuring our organizations to a more horizontal model that distributes resources and management focus across elements of the continuum (e.g., home care, senior services, primary care, etc.) and does not put the acute care operation at the center? Are we leveraging skill and scale by developing system services that provide needed expertise in care management, data management, Lean thinking, training and development in population health, and so forth?

Strengthening leadership. Is there an opportunity to develop or recruit physician and administrative dyads that bring new competencies to the organization to move us from Point A to Point B, including physician leadership development, group practice management, patient-centered medical home experience, population health management skills, etc.?

These are just some ideas to "prime the pump" as we adopt a panoramic view regarding the future of health care delivery and financing. We can make a difference by thinking and acting differently!

Michael Slubowski, F.A.C.H.E., F.A.C.M.P.E., is the president and chief executive officer of SCL Health System in Denver. Before joining SCL Health System in 2011, Slubowski held senior executive management positions for Trinity Health in Novi, Mich.