In residency, I learned that it is a sign of strength to admit ignorance and ask for help.  While  writing my latest column  for the Journal of Healthcare Management on Innovation in the Face of Recession, I realized that  little has been written recently on that subject in healthcare.

 So, I asked respected thought leaders what they were doing and what was working.  I ended with the following question:

• If you could be granted three wishes, what would you request?

Their responses fell into several thought-provoking clusters:

• Regarding healthcare reform, over one third wished for a more efficient system that decreased red tape and made it easier for people to collaborate inside and outside their organizations.  Such collaboration included sharing information about outcomes and improvement programs that worked as well as aligning incentives, so that we have a system of interdependent parts rather than a collection of cottage industries.  In Collaborative Conversations, I wrote that the challenge of any meaningful healthcare reform efforts is the extent to which they engage healthcare professionals to make a difference in patients’ and families’ lives.
• The above response tied into to their wish for a nationwide information network that would help providers and organizations be more accountable for outcomes and help them integrate care throughout the inpatient/outpatient continuum.  As one respondent wrote, “Know more, act prudently, measure outcomes.”
• Physician staffing also entered into their responses, especially primary care providers and orthopedic surgeons.  As I mentioned in Field-tested Strategies for Physician Recruitment and Contracting, not only are patients aging and their care needs becoming more complex, but health care providers are aging along with them, and younger physicians tend to have different expectations about work-life balance than colleagues who were born before 1965. Of the physicians practicing in 2005, 36% were at least 55 years old and over 15% were at least 65 (Cohn KH. Harlow DC. Journal of Healthcare Management. 2009; 54(3):151-158).
• Several participants wished for patients to become more cognizant of their role in improving healthcare outcomes, specifically regarding nutrition, exercise, and safe decisionmaking related to seatbelt use, alcohol, and protective barriers in those who have multiple partners. As noted in Collaborative Business, here is an area where insurance companies and large corporations are providing innovative incentives, such as a 24-hour help line, exercise facilities, smoking cessation programs, cancer screening, diabetic education, and trans-fat free cafeterias.
• One person wished for targeted management and leadership training.  As I wrote in Collaborative Leadership Development, summarizing Growing Leaders in Healthcare by Brett D. Lee and James W. Herring, 85% of Fortune 500 companies sponsor formalized internal leadership development programs, but only 21% of US hospitals have formal processes for identifying and developing candidates for leadership positions.
• Another wished for an intellectually stimulating environment in which to work.  In Collaborative Listening, I mentioned Brian Wong’s survey of over 1,500 practicing physicians, where meaningful work that makes a difference in patients’ lives ranked as the top priority.
• Finally, about 10% of respondents made ”spiritual” wishes to restore a sense of mission, purpose, and professionalism, reconnect with the reasons they initially chose healthcare careers, and have the courage and wisdom to make correct decisions in difficult economic times.  Not only did they seek incentives to encourage cooperation and sharing, they also sought an abundance rather than a scarcity mentality to confront our current challenges.  In Collaborative Gnosticism, my mentor, Lee Kaiser, stated that most people and  organizations see themselves at the center of the universe, which leads to egocentric, self-interested approaches that facilitate exploiting others for competitive advantage, hardly a sustainable approach to the service of others. He maintains that there is no economic, social, or political solution to the current healthcare crisis.  Spirituality, based on abundance, collaboration, and sharing provides the only solution because it makes problems disappear.

 What do you think?

• Despite the strident debate over healthcare that we are witnessing in the news media, do we largely agree on the rationale for improving our clinical and financial outcomes
• If we agree on the why and and the what, can the how become a lifelong  iterative journey
• What three wishes would you like granted

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

Kenneth H. Cohn

Addendum: Anyone wishing to take the aforementioned survey and have your responses mentioned in my upcoming column, please copy the questions below, paste them into your e-mail program, and send your responses to ken.cohn@healthcarecollaboration.com by September 11, 2009.  Thank you for your input:

• How are you and your organization doing in these difficult economic times?
• What are your greatest concerns?
• What strategies have you found to be the most useful in dealing with your concerns?
• What strategies have not proven to be helpful?
• If you could be granted three wishes, what would you request?

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