The health care system in the U.S. is Dickensian: We find ourselves in both the best and worst of times.
Medical advances – devices, diagnostic tools, drugs, facilities, and virtually all of the basic mechanics – are improving every day. We are better at medicine, know more about medicine and have an R & D infrastructure that holds the promise of solving many, if not most, of the intractable problems associated with basic human health. We seem to be in a near-Golden Age.
At the same time, our public discourse, social paradigm that defines health care, and basic assumptions about what and how we deliver medical care – and how we pay for it – could not be worse. Look at the state of medicine in the U.S. and you’d think we are masters of the universe. Listen to us talk and you’d think we’d all gone nuts.
The national dialogue is about payment systems, and it should be about cost. The national dialogue is about expense, when it should be about consumption. And the national dialogue is about who merits what, when it should be about dignity and human autonomy.
But there may be good news for any and all who are engaged in the health care field: We can transform health care delivery overnight, with just a few tweaks in how we talk about health care. Sadly, though, this transformation – as simple as it might be – depends on trust, logic, and compassion in equal measure. And that just might be the real challenge of health care in the U.S.
Over several weeks, I’ve been in conversation with leaders in healthcare, including practitioners, policy leaders, researchers and innovators, and leaders of large-scale delivery systems. Those conversations were all focused on understanding the biggest impediments to innovative thinking and innovative deployments. As varied as the points of view and perspectives are in all those conversations, three issues continue to surface everywhere. I’m convinced now that the national health care conversation we need to have is impeded by three deficiencies: an absence of trust, a zero-sum game mentality, and fear of failure.
At the very core of innovation and our ability to solve complex problems in complex ecosystems, you will always find one key element for success: Trust. Most importantly, trust is what can dramatically speed up and lower the cost of transactions, and transform the path to innovation from slow and plodding to rapid trial, invention, and deployment. Trust binds organizations and individuals in powerful ways, not least of which is comfort in failure.
But our national conversation is grounded in, and seems to feed on, an absence of trust. Who in a bitterly partisan world is going to cede trust to a political opponent? What political leader is genuinely engaged in working with “the other side” in a trusting manner? Likely no one. What we have instead is a “conversation,” that is fundamentally aimed at one side being right at the expense of the other side being wrong. The outcome is inevitably discord, anger and frustration – and little to no actual progress. Unless we are able to re-establish some level of basic trust in our legislative process, we will continue to get the results we enjoy today: Not much.
The absence of trust fosters the second impediment to healthy, innovative, and effective health care conversation: A zero-sum game mentality. A healthy innovation ecosystem – be it a corporation, a country, a region, or any organized system – is collaborative by nature. True innovators, defined as leaders and organizations whose focus is on creating new and better solutions to problems, are focused on winning the battle against the problem, not the battle against others. And in this healthy environment, energy is directed toward innovation, not competition.
In our health care conversation, the emphasis is almost always on making someone lose, not making everyone win. This is critically important to why we are failing at so many things in health care. At the level of national discourse, it does not stretch the point to assume that no one, not a single, solitary leader, is interested in a win/win approach to health care innovation. In fact, the opposite is true. Our national debate revolves almost completely around how to make someone else lose. What else can we expect but dysfunctionality?
Lastly, there is the issue of failure, the handmaiden of innovation. In healthy, productive organizations, there is a cultural understanding that failure is a near-inevitable factor accompanying innovation. That’s not to say that failure is a welcome goal. But when innovative practices are emergent, failure is understood, contextualized, and accepted in an appropriate manner. In this context, failure is not failure – it is learning.
Not only is our national conversation about health care untrusting and conducted on a win/lose basis, but failure is seen as an opportunity to damage an opponent, not as part of an innovation process.
We have become so inured to our political conversation that we simply don’t notice that failure – any failure, big or small – is anathema to conversation. One has only to look at the Affordable Care Act deployment to see every anti-innovation element at work. Regardless of political viewpoints, it’s safe to say that the conversation about the less-than-effective ACA rollout has not been focused on how to improve it. What could have been a productive, healthy, innovative “good failure” became simply a political hot potato. And the learning that could have occurred was lost.
The real enemy of health care innovation is not medical, scientific, or even organizational. It is in fact our inability as a nation to conduct genuine dialogue that is modeled after innovative ecosystems.
Unless we learn as a society to value and develop cultural norms that are solution focused, rather than power focused, the extraordinary work that is being done in hospitals, clinics, labs and other arenas will simply not be optimized. The solution –the innovation – we need to change is virtually cost-free. All we really have to do is learn how to talk.