Don't be afraid of change, USA!!

History is, at the end, a description of all the changes that got us here. And, more than ever in my life, I feel like we're at the confluence of strong currents of change that are more impactful because they aren't as explicit as the neon flashes of the 60s - they are undercurrents that are changing the very fabric of society.

Image credit: FreeDigitalPhotos.net & Stuart Mileson

America's reaction to the Affordable Healthcare Act, rather radically captured by the shutdown, is in many ways typical of what one can see every day in organizations going through change. And hence, one can only hope that someone on the hill is thinking like an change manager - the President, maybe?
What does a good change manager do?

• Be explicit about the vision for change - what the issues are and what the future looks like: Despite what the skeptics like to say, I fully believe that Americans, like all sane individuals, are inherently rational being, and not just in the economists sense of the word. Clarifying why a seemingly even keel (if expensive) system needs to be changed or improved is an essential first step. And that's not just at presidential bully pulpits...it's in community centers, hospitals, medical conventions, opinion pages...and it's through clear pilot data that shows what the impact can be through clear metrics and examples
• What's broken (see more below)
• How will change happen - laugh as much as you want, but 10 powerpoint pages in 14 pt can be pretty effective, certainly much better than a large multi-chapter report
• How will we know we are succeeding? What are the metrics?

• Get the leadership aligned: It was surprising to hear about democrats who weren't in support of the AHA. At the end of the day, if an executive team is divisive, the broader system believes the proposition of the new vision doesn't hold water. Brinksmanship doesn't do anyone any favors.
• And, a sub-set of that, is that old dependable adage - know your enemies, and keep them close....
• Communicate to all levels of the population and system:
• Change happens for the systems, but to the individual too...and every bit of the system in between. Talk to the prince and the pauper, the hospital system and the doctor, to the republican and the independent
• Be systematic in communicating and managing the change through the system - decisions will change, the way they work and are rewarded (or treated) will shift - get out there or send your representatives out there to truly pave the way for understanding and acceptance of these changes. That's called the cascade - make sure it happens!!
• Integrate your knowledge of the the culture of the organization/ sub-populations: The handly part of the way the political system works is that you have people who ostensibly know their populations - our wonderful representatives on the hill. Had they been used to properly communitcate not just the party line (if they did that) but also the reality for the regions and sub-populations they represent, then the change is less friction-producing... in the best case it can become more of a pull from the people than a push from up on high
• Address these cultural needs explicitly - not just cosmetically or in your communication approach. Make sure that you recognize the diverse needs and constraints of your people in the solution you are developing.
• Show visible ownership across the system: Unfortunately, there seems to be only one explicit owner of the AHA - hence the monicker "Obamacare." No so, folks, this is USAcare...and we need to have all kinds of owners: economists, doctors, hospital chain representatives, patient advocacy groups, AARP...I could go on.
• Have a plan for when things blow up. I've tended to freak out clients what I've asked them if they've done a pre-mortem. Basically, it's my way of laying out all that can go wrong, and define how we'll address those issues. About 50% of the time, the client engages...and we're always happy that we did it.  

My hope is, all indications to the contrary, someone in DC has a change plan. The US and our healthcare system is worth working for.

As Mary Varghese, Healthcare Executive and Strategist, so eloquently puts it:

"I believe we have the greatest healthcare system in the world, and I also believe it is fundamentally broken.  As someone who has been a student of the healthcare system for 18 years, my view is that the mere notion of the ACA has made significant strides to transform the system of healthcare we have in the US, regardless of whether the Republicans successfully shut down what's left of it.  Healthcare is 18% of the GDP and growing, yet the system has been highly inefficient and unsustainable.  The market response to merely prepare for health reform has already started shifting the system to one that keeps us healthy rather than one that takes care of us when we're sick - an actual "health" care system instead of a "sick" care system.  Buzzwords, such as accountable care, payment for outcomes, patient engagement, and the growing use of electronic health records (EHRs), have moved from policy-wonk talk to popular culture, showing up in the NY Times Magazine, New York Magazine, and the New Yorker.  These terms are not strictly tied to the ACA, they are not predicated on the success of insurance exchanges or increasing access to millions more.  These terms are starting to permeate the consciousness of the lay audience because the market is coalescing around these initiatives - they are rapidly moving from concepts being incubated to programs being scaled.  With growing consensus on things that could work, we began to see action.  From our national priorities came local innovation, a la the American spirit.

A key issue in our healthcare system is that the incentives are so misaligned, it's a domino effect when one considers the interdependencies inherent in any "fix" to the system.  This is precisely why a fix of any kind eluded us for so long.  And this is precisely why efforts to repair and reform our healthcare system come with such divisive, charged reactions.  Because to align the incentives, players in that value chain that have been winning, or learned to make do in the face of chaos and disorganization, will lose out.  And this fear perpetuates more fear and recalcitrance.  I'd be far more worried if we didn't see the reaction we are seeing today, because that would mean we weren't doing enough to align the value chain and therefore, would not see sufficient impact.  Aligning the value chain is a disruptive thing.  Almost as disruptive as the creation of Medicare, the introduction of DRGs, the advent of "measuring" physician performance and more recently, policy pressure to adopt EHRs.  Yet with each one (the EHR example still in mid-state) the disruption played out and became another layer of our complex healthcare system, with all the players figuring out a way to make it work.  Today, market forces are figuring out how to "win" in a healthcare system that prioritizes value: value to the patient, value to the payer, a tightly aligned value chain."