18 Factors for a United States leadership role in health care.
When beginning an initiative, it’s important to design the end state first. Some call it vision. Others call it target environment. Why? If you jump to the details, the funding, or the “how” of it too soon, particularly when the issues are as complex as those related to health care reform in this country, then you get unfocused and mired in useless debate. Rhetoric / conjecture become the substance rather than the side show. Shockingly, that’s where we are already on the topic of a new U.S. health care system, despite the lessons of the past, most notably the failed efforts of Hillary Clinton in 1994 - 1995.
So this time, rather than settle for the lowest common denominator, let's do it right. In this regard, I like to help my executive coaching clients set a high bar. I suggest they develop their vision by identifying “conditions of delight” (“COD’s”)—what common ground would have the majority of participants / stakeholders (in this case, Americans) be quite pleased with outcome (in this case, with a new health care system)?
Since politicians, especially the detail-minded President Obama, jumped directly into the “how,” rather than set a vision and obtain our buy in for that, it’s time to back up. Why do I say that? Well rhetoric and conjecture were the reaction to his first round of ideas. Criticism is being leveled before the ink has dried (e.g., “single-payer!”, "socialized medicine!", “giant government-run bureaucracy,” “administrators will get between doctors and patients,” “costs out of control,” etc.) We have indeed plunged into a derailing debate about the “how” before the “what” is defined.
What do we want? Here are my own conditions of delight – the vision / end-state – that I’ve been able to piece together from all I’ve read and watched. In my view, the list below reflect what must be true for the majority of Americans, including corporate interests that aren’t planning on disappearing anytime soon, to be pleased with health care reform. Once we decide on specifically what these look like, and how we measure them, only then can we create the “how” of implementing them.
1. Every man, woman, and child in America will have decent health care, including preventative, diagnostic, inpatient, outpatient, rehabilitation, and necessary medication.
2. Access to medical services will be timely.
3. Costs to Americans for their health care will be affordable for all.
4. Costs to the federal government for health care will be deficit-neutral.
5. Quality of health care in America, on average, will improve from its current state.
6. People who want and can afford “premium” health care services (by accessing providers either at home or abroad) are free to do so.
7. Standards of care and health care decisions will be designed and made by medical professionals, families, and patients.
8. Individual’s health information will be private and portable.
9. Security against scamming / gaming / fraud will be designed into the system.
10. Quality measurement and continuous improvement will be designed into the system.
11. The current health and medical malpractice insurance industry will not be destroyed—it will be actively involved in the redesign of the system, and reinvention of themselves.
12. Health care providers will no longer be required to pay exorbitant malpractice insurance premiums.
13. Financial damages for medical mistakes will be reasonable for providers and patients.
14. Pharmaceutical, biotechnology, and medical device researchers, developers, and manufacturers will not be destroyed—they will be actively involved in the redesign of the system, and reinvention of themselves.
15. Pharmaceutical, biotechnology, and medical device developers will be incentivized to find / deliver cures rather than permanent, chronic dependence on prescriptions.
16. Medical research is funded and thriving, and we continue to be a leader in this area – from basic science to practical application.
17. Medicine as a profession is respectable and pays well.
18. Medical education—from technicians, to doctors, nurses, and public health practitioners thrives and generates best-in-class graduates.
Let’s stop trying to engineer the details before we know what we’re building. Encourage your representatives to vote against anything that tries to build the “how” before we can begin with the end state in mind
David Peck
Executive Coach and President
Leadership Unleashed
Palm Springs, California
