I want to bring to your attention a summary of a new book, The Necessary Revolution, by Senge et al.

The title derives from the authors’ belief we must implement revolutionary changes rather than incrementalism to improve the way we work and live.  They use examples such as Northern Sweden’s global villages that cut energy use 80% by collaborating across boundaries and using systems that connected businesses.

The authors feel that four drivers compel us toward a more regenerative economy:

• Side-effects of industrialization, including waste and pollution
• Proliferation of “civil society stakeholders,” such as non governmental organizations, who monitor the world and make it difficult for organizations to operate in secrecy
• Increasing global economic and environmental interdependence
• Emerging disruptive technologies in fields such as genomics, nanotechnology, information technology, and renewable energy

These drivers underscore constraints that we deal with in healthcare, one of the most rapidly changing sectors in the economy.  A surgeon confided in me, “Only a baby desires change.”  Clearly, we can view change as both a threat and an opportunity to improve access, service, and clinical and financial outcomes.

To paraphrase the “dance of the blind reflex” (Oshry, B. 1996. Seeing Systems: Unlocking the Mysteries of Organizational Life. San Francisco: Berrett-Koehler):

• People at the top of an organization feel burdened by unmanageable complexity
• Those at the bottom of an organization feel oppressed by insensitive higher-ups
• People in the middle feel torn and become weak, confused, and fractionated
• Physicians, patients, and families feel righteously done-to by an unresponsive system, which irritates hospital leaders, who feel that their efforts are underappreciated
• Nobody sees his or her part in creating and sustaining any of the above conditions

Senge et. al. wrote that innovators have learned to see the larger systems in which they live and work.  As I pointed out in The Tectonic Plates Are Shifting:Cultural Change vs. Mural Dyslexia, not only do we have systems, but the systems have us.  Working to see the systems that occupy our thinking helps us to see the part that we play in enabling processes that do not serve patients, families, or the communities in which we live and work.

 Many of the limits we face are “commons,” shared by others; one example might be the proliferation of imaging centers.  According to Senge et. al., we need to step back, see the larger limits and what they mean for patient care, and work to build a stewardship ethic, helping others to realize that we share a commons that will support us only as long as we learn what it takes to support it.

Rather than telling people that their thinking is outmoded, Senge et. al. encourage us to reflect on our assumptions.  As we expand our understanding of issues (rather than blaming one another), we will see more clearly the underlying forces and the opportunities on which we can capitalize and create a virtuous cycle in which:

• An improved practice environment drives better clinical and financial outcomes
• Which make it possible to improve existing services, invest in new programs, and recruit and retain talented healthcare professionals
• Which drives an ever-improving environment in which to care for patients and their families

What do you think:

• Is healthcare collaboration an iterative journey
• When done properly, can collaboration result in exciting, new ways of working
• Does being part of something larger than ourselves provide satisfaction and meaning

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn