Change is in the air. Some pundits point to a new healthcare system; others point to something a little less dramatic on the edges. No matter how one views it, change definitely is afoot.
The last time I recall a similar feeling was 1993. There was a general feeling then among many in healthcare that a unique convergence of events might result in healthcare reform. Because of the similarities between 1993 and 2008, many people are naturally wondering whether the atmosphere is similar enough to again result in reform this time.
What do we know about healthcare in 2008 as opposed to 1993? Well, an even greater share of the United States economy is based on healthcare. The quality and patient-safety movement has arrived. There is a greater discussion about pay for performance. The effects of consumerism are being felt by all healthcare providers. There is evidence the United States does not have the best healthcare.1 There still are some physician shortages, and predictions of greater shortages, albeit in different areas then 1993. So, if anything, the burning platform for change appears brighter in 2008 than in 1993.
As I reflect on these facts and the differences between then and now, I think of the principles of change management.2,3 Establishing the burning platform or the sense of urgency is only the first step in change. It is a vital one, but if the next steps are not completed, hard-wired change does not occur.
The second tenet of change management is that you must pull together a guiding team. There must be a powerful group guiding the change—one with leadership skills, credibility, communications ability, authority, analytical skills, and sense of urgency.
This is the main difference between 1993 and 2008 and one that convinces me we are on the road to change in healthcare. For the biggest difference is you. In 1993, there were several hundred hospitalists in the United States. Now, there are approximately 20,000 and a robust professional society to help manage and lead the group.
You are the guiding team. Why? In many mature hospital medicine programs, hospitalists account for the majority of a hospital’s admissions. Add this to the fact that more than 30% of healthcare is spent on hospital care. The result is that hospitalists through their pens control a significant amount of the healthcare market. Hospitalists have the leadership, authority, and credibility to be the guiding team. And when I see the tremendous skills of hospitalists in guiding new programs and serving as medical staff leaders, I am convinced hospitalists are the nation’s guiding team in healthcare reform.
The third step in change management principles is deciding what to do. There must be a unified vision and strategy. I am not as confident this vision is fully formed yet and hence one of the reasons we won’t get change immediately. To create a unified vision and strategy, we need additional innovation in hospital care. Granted, hospital medicine is a relatively recent innovation; we are far from done developing the right care mode for hospitalized patients.
What is the area we need to innovate in the most? Our practices. While there is much innovation occurring in hospital medicine, we need to continue aggressively pursuing new methods of care delivery. Year after year at our annual meetings, we see tremendous evidence of innovation in the numerous abstracts presented. Still, we must try to take it up to a new level. The present way of doing things isn’t sustainable. We cannot completely care for patients by merely working harder in our current care-delivery model. Working differently or fundamentally redesigning our jobs will help us. It will help us see more patients and deliver greater quality, all while maintaining high degrees of personal and professional satisfaction.
Do not leave the innovation up to others. Each of us must continue to assess how we deliver care through a team model. We must evaluate how to better integrate with midlevel providers. We must lead in transitions of care and discharge planning. We need to re-examine the basic model of physician-patient care. We must make sure residency and post-residency training prepare hospitalists for all of this. Finally, we need to innovate on how hospital administrators and hospitalists work together to improve quality and patient safety.
Don’t forget to share those innovations with SHM. SHM is your conduit to change healthcare—and if you take things to the third step of change management, SHM easily can help you through the remaining steps. TH
Dr. Cawley is president of SHM.
- Davis K, Schoen C, Schoenbaum SC, et al. Mirror, mirror on the wall: an international update on the comparative performance of American health care. Commonwealth Fund: May 2007.
- Kotter J. Leading change. Boston: Harvard Business Press; 1996.
- Kotter J, Rathgebar H. Our iceberg is melting: changing and succeeding under any condition. New York: St. Martin’s Press; 2005.