So we are at an inflection point in health care in the United States and actually, in the world,
where the pace and the magnitude of change is not like nothing we've ever seen before. And I
think the important thing for us to understand and get comfortable with is that there is no
solution that's evident. There's no playbook, there's no road map that we all can just pick up and
follow. And therefore, it's incumbent upon all of us as leaders, I think, to not only take advantage
of the opportunity to shape it but also, the responsibility to shape it.
So I always use this phrase by Russell Ackoff out of the University of Pennsylvania, "Plan or be
planned for." And I feel that, for decades, we on the provider side, in particular, have been
planned for. And who has a closer relationship to patients than the providers? And I think we
need to reground ourselves in that, and we need to, in this time of flux, grab a hold of it and
shape it to the betterment of health care for individuals and frankly, to get to a sustainable model
for this country.
If we're spending almost 18 percent of the GDP on health care, I believe what Don Berwick said
25 years ago when he was first with the IHI, "There are enough resources in the health care
system. Instead of looking for more, how do we put our arms around those and really drive to
their optimal use?" And that is all about value.
This year is the 30th year I've been in health care, and one of the most frustrating, but I think,
important things, for leaders to understand is that unlike many other industries, the level of
politics and emotion that come into play in decision making really out-strips a lot of rational
thinking. And the only thing that can surmount that effectively and efficiently is leadership. So
again, I just keep coming back to say, there are some people who are daunted, or paralyzed, by
where we are in health care. There are others that say, "Wow," you know, the Stockdale Paradox,
"Give me the brutal truth but don't be confused. We're going to take the Hill."
And I think that that's what, again, is the opportunity and the responsibility for us as leaders at
this time in health care. If we wait for some policy, grand policy scheme, to emerge, we will
have lost a lot of opportunities. So absent that we have to step up and lead and I think leading not
only the work in the field, on the front line with our caregivers, but at a policy level.
And our CEO at the Cleveland Clinic, Toby Cosgrove, gets a lot of criticism for being anywhere
in the new administration, yet we've talked a lot about it internally. It goes back to this "plan or
be planned for." We need to have a voice that is not the recipient of policy, planned for, but
actually shaping that policy. And I think we need more of that because it's striking to me how
few people truly understand the intricacies and nuances, the inner relationships and inter-
dependencies inherent in health care. And, if you try to solve that one-off, clearly you're going to
end up with a sub-optimal result, and I think we've had a lot of that.
Today, about, at least for us, anywhere from 60, in some cases, for other organizations, 70
percent of the reimbursement that a health care system or organization, hospital, receives is
government based. So it's been subjected to the policies of government in terms of how care is
going to be organized, going to be delivered, going to be reimbursed, and that's an element of
"planned for." I think the same thing . . . we are a cottage industry, so health plans have taken a
very large part of shaping and in many cases we've been the recipients of whatever policy has
been planned for us. So I think there's an opportunity to get to a better balance in that regard.
I think that we are unclear as a country, whether this is a public good or whether this is . . .
market health care is not a normal market. It's somewhat of an artificial market that's shifting a
lot. But again, I think, for me, it comes back to, for our not-for-profit organizations, the
shareholders are the communities. It's not some group of people that gets dividends. It's the
community. So as leaders, we have a responsibility, I believe, to say, "How do we take these
assets and apply them to their highest use for the communities that we serve and are responsible
for?"
And my thinking, it really ends up being a combination of collaboration and competition on
some fronts, and that's a tricky dance, but I know that for the work that I'm doing, we're doing,
there's a strong element of that. We're collaborating with people who, heretofore, have been
competitors. But again, how do you find common ground so that you are really getting a higher
return on the collective assets than you can in a competitive front?
For example, we have six pediatric hospitals in the state of Ohio. If you look at the volumes,
none of us has a critical mass to be able to do them all clinically or financially. So obviously, we
could continue to compete or we could figure out ways to leverage our collective resources to a
higher value equation than we currently may be getting. It's tricky, but there are models, business
models, that can demonstrate mutual value. And, I think, it's not as though one wins at the
expense of the other but, you know . . . and those are complicated, but I think that those are
necessary steps for us to move forward.
I think that while we are figuring out at a macro level, what this entire, moving from, as Bob
Kaplan says, "a sector" to a system, a health care system, which implies that there's integration,
that there's rationalization, that it works and it's in a rhythm. It's not, everything is unique and
chaotic. I think that, until that occurs or we create that, there's so much going on all over the
place, these jewels, that we need a simple mechanism to collect those, to characterize those, to
share those, and to spread those.
So I'm pretty excited that we're in the room together, leaders from all over, people who have lots
of ideas, people who have lots of work going on. And I think what undergirds it for me is just the
level of passion and commitment to figure this out. No one came here looking for the silver
bullet. But you see, as you reflect on the conversations, you look at the people, you have hope
that it's groups of people like this that will figure out how we move from where we are today to
something that really is great and sustainable for this nation.
I'm very excited. I do believe we have an abundance. Is it scarcity or abundance? An abundance,
a munificence of resources, and great people. I think that's the thing I love about working in this
sector is the people that I work with, and it's not just where I am today, it's where I've been for 30
years. Just amazing people who can do amazing things, if we give them the right leadership and
if we give them the right operating structures in which to do that.
So yes, it's going to be very rocky. There are land mines everywhere. There are snakes, dragons,
pits, whatever, everywhere. But, if we are collectively, as leaders and teams, working through
this, I have to believe we can get to a better place
