In my recent encounters with leaders who are fostering healthcare innovation in Vermont, I have observed that leadership within the ACOs, The Vermont Medical Society, forward-looking and socially oriented members of Faculty at the UVM Medical School, the leadership of state health agencies, members of the legislature, the governor and the local leadership of the regional health areas all have a high degree of understanding of the principles of the Triple Aim, the domains of quality as described by the IOM in Crossing the Quality Chasm and its functional description of a better healthcare organization. The individual understanding of leaders may exceed the measured success of their many combined efforts.
Despite all of the efforts to foster change in Vermont it appears that many physicians and many patients do not understand what is happening and are not actively engaged in the process of transformation that others are promoting. It is hard to imagine that change can go forward or that patients will ever understand or appreciate the promises of universal high quality and affordable care if their physicians are not engaged. One faculty member who is actively engaged in the process of transformation in Vermont suggested to me that at least 85% of practitioners are so busy with “today’s work” in the volume based fee-for-service economy of current healthcare economics that they are minimally informed and have limited participation in all that is happening. Individual physicians are not optimally engaged and as a result they may be resistant to or do not understand much of what is happening around them.
The widespread engagement of physicians as leaders and facilitators of change is the single most important strategy in healthcare transformation. Physicians must understand and accept the compelling need for change and be willing to contribute to the evolution of the operating model and the economic platform, or at a minimum, support and accept the efforts of their colleagues who are willing to more actively engage. Each physician has personal views and fears about the process of change in healthcare but the following hypothetical statement seems to apply to a majority of those who are at least willing to listen:
I am going to be very resistant to change unless I have reason to believe that the change is good for my patients and me and that there is a very compelling reason for me to participate. I need to know and understand how the changes I am being asked to make contribute to a larger organizational and social vision. I need to know that my colleagues and clients believe that this is something that we should do. I need to believe that those to whom I look for leadership believe that this is something that we should do—and show it in their behavior and commitment, personally and organizationally.
I can successfully change if I have the physical, mental, and emotional capacity required or have the support to fill the gap between what I have and what is needed while I grow. I need support to acquire the knowledge required to change. I will need assistance to acquire the new technical skills required by change. I need to trust that when I ask for help I can find it. I will change if I can exchange ideas with others on the journey and have metrics to help me reduce the ambiguity and understand my progress and our collective progress toward shared goals. I need assurance that there will be personal and structural incentives and facilitators for making change.
[This statement by a physician was imagined by me as a response from a hypothetical physician and structured from a template offered by emeritus BU professor of education, Dr. Alan Gaynor. It could also apply to other healthcare professionals and, with minor modifications, reflect the sentiments of a concerned consumer.]
