A cartoon caption in a recent issue of The New Yorker magazine gave me pause for thought. It showed a man writing at a computer with an angry expression on his face. Adding a new twist to an old saying, he looks up and says to his cartoon companion: "Those who can't do, comment."

For me, it captures the sentiment of how so many people "communicate" in so-called modern times, and particularly in an election year, when it seems that there are more commentators than events or episodes to be commented on. Even a half-hour with cable news is likely to send the most logical but entrenched couch potato running to save his sanity.

Within our neck of the woods, health reform and system transformation also have spawned what can seem like overwhelming commentary — much of it at a very high level and generally unprovable, or so granular and lengthy that you can feel your brain becoming detached from your body. Then there are the folks who are just plain angry about practically everything that has ever happened — or didn't happen — in health care, or might — or might not — happen in the future. And they're going to stay mad, by golly!

Everybody means well, I think, and some of it is strategic and thought-provoking. We can all pray for a little more entertainment value.

Now, having said all that … Just from listening to more casual comments from those of you who are actually charged "with the doing" — and when the "I am a CEO persona" business dial is turned down a few notches — some random themes that are not particularly on the grand scale emerge that deserve to be poked at a bit more.

Watching the neighbors. Everywhere, people are watching what strategies everyone else in the community or region is trying out, waiting to see what works, or flops, while they stay in learning mode. That's fine. But how many times have we seen something work very well for one hospital or one system and then fail spectacularly at another? Hospitals are a unique mix of culture, personalities and random circumstances that make it difficult to import innovation from one place to the next without paying attention and adjusting all of your own individual factors.

Project management mode. System transformation is not the same as project management. From the board on down, the vision has to be the same and all-encompassing. We can't assign a team to parse out a plan with specific steps, put this and that in place, and move on. Transformation doesn't have a start and an end date. It's more like a way of life.

Service line management surprise. It's in, it's out, it's back. Those LeGrande Silos of health care, service lines, have seen more changes in management theory than hemlines and tie widths since the 1950s. Now, the current wisdom is to eliminate the unprofitable ones and co-manage with physicians to make the core services work. Simultaneously, some hospitals are successfully reorganizing patient populations into clinically meaningful subgroups, such as by disease or severity, and bringing a defined set of pathways and broader resources to that group of patients, which doesn't sound like, well, service line management.
Well, we won't be bored at work for awhile.

— Let me know what you think. You can reach me at mgrayson@healthforum.com