Mea sententia

Unless you have been living in a cave for the last 5 years, you have heard lots of talk about Web 2.0 and Health 2.0, the 21st Century versions of the internet and the health care system.  Changes in technology, social structures, medical science and culture has led to huge changes. Is the same thing happening in the fields of management and leadership? Is there a management (or leadership) 2.0 just over the horizon? If so, what would it look like in health care?

During medical school we were admonished never to take short cuts. High on the list of forbidden behaviors was to fail to do a complete physical exam, regardless of how focal the presenting problem seemed. For one thing, our diagnostic skills were in their infancy, and narrowing the focus too early was a way to miss important things. For another, there is a wide range of normal and multiple exams would help us recognize an outlier. The relationship with the patient was felt to be enhanced by the process of a methodical and attentive exam with laying on of hands.

The language of medicine is highly evolved and complex and allows clear, detailed, specific and unambiguous descriptions. Except when it’s not.

Now that winter is over and I am reviewing (and largely discarding) the snow photos I took, I am struck both by how many there are (reflecting lots of cold shoots) and how disappointingly few are worth keeping. I think I see a hopeful trend towards improvement over the season. Here’s a summary of what I have learned this season. It may benefit someone else - but it is mostly to get me started next winter where I ended this spring. The photos are from one of my last skis of the season.

Collaborative activity is a tremendous asset for a business or community and a wonderful thing to experience. Unfortunately, it becomes exponentially more challenging - and less common - as the number of participants rises above one.  Too many managers and C-level administrators settle for some lesser form of group activity, often proudly boasting of their collegial and collaborative approach, hoping no one will notice.

Let’s review the characteristics of four kinds of group behavior, arranged along a spectrum ranging from simple compliance to  collegial collaboration.

Wind’s blowing.

Still snowing.

Drift’s growing.

So let’s go ski.

It’s getting bad.

This weather’s mad.

Don’t be sad.

So let’s go ski.

It’s almost night.

No lights in sight.

Dress up tight.

So let’s go ski.

Life is tough.

Luck is rough.

Hope’s not enough.

So let’s go ski.

It’s not just snow.

Where cold storms blow.

It’s life you know.

So let’s go see.

When we were a group of four primary care providers it was easy to share information, communicate and work collaboratively. Having grown to ten, we struggled. As our lives became more hectic, our time scarcer, and the number and complexity of issues grew, it became impossible to manage practice governance, pursue QI projects, develop work flows, and deal with directives from our parent organization. Keeping everyone in the loop was simply not possible. Even if we could get all ten providers in one place for an hour/week, the task was too large to squeeze into an hour a week.

My first appointment on that rainy Monday morning was a 24 year old woman there for her annual health maintenance visit, Pap and contraceptive review. We talked about her wedding...

It’s a common complaint: “Where is everybody? We built a great new tool and nobody is using it. I don’t understand. It’s important for our organization that everybody participates. How can I make them join in?” 

The call came just after breakfast on a Saturday.  A patient of one of my partners was hoping I could do him and his employer, Bates College, a favor and see a woman who was not a patient in our practice. She was visiting from out of town to see her grand nephew graduate on Sunday but had taken ill, and was reluctant to visit the ED.