Why is transformation so difficult?

Transformation in healthcare needs to occur within a complex dynamic system (i.e. a chaotic mess). Clear communication, shared goals and problem solving are especially challenging in healthcare environments. There are multiple and sometimes conflicting missions. The socialization of healthcare professionals is fragmented and often exists outside the organization and pre-employment. Our organizational structures further strengthen these silos. There are incredibly strong external pressures, constraints and influences from multiple stakeholders (payers, consumers, government agencies, etc.). The core tasks in healthcare often occur locally in complex, dynamic, and ambiguous situations and settings. Patient-driven variability is often a necessity and yet there is a good amount of unnecessary variability. Healthcare is pluralistic. It’s a conglomerate of missions, values, stakeholders, professionals, regulations, processes and practices.

Here are some transformational changes we’ve all been considering with my assessments of where we are:

Team-based care –We’ve been talking about it so much it’s become a cliché, yet we’re not so good at it.  If we actually did it, it would be transformational.

Deeper and expanded competencies – Lot’s of problems get in the way of this, and we’re dreadful at solving problems in healthcare.  This tactic is necessary for reducing costs.  All stakeholders (internal and external) need to get on board.

Explicit goal setting incentivized using internal and external motivators – we think we’re good at this, and we’ve gotten better, but we’ve not transformed how we do this. Why? Because we think we can set goals at the highest level and have them make sense at the local level. Hello? McFly? It doesn’t work.

Local change with targeted centralized support – uh… what we ask for too often is local support for centralized change. Is that you again McFly?

Feedback and redesign with front-line workers and patients at the center of the work. – Who has time for that?  We can do this, but only if we integrate it into our daily workflows and practice.

Use systems, process and team-based thinking. – ugh.  Clinical pathways help change the paradigm and demonstrate the benefit of doing this, but one problem is that professionals don’t know how to do this kind of work without a lot of coaching.

Agile engaging high-performance management systems – Does anyone in healthcare even know what this means?

One last thought…Many of us have been on a journey to point out what we consider to be a cancer in healthcare - variability.  Could variability be the malady of all maladies for healthcare?  Yet variability is often necessary as is cell growth and tissue regeneration; variability at the right time applied to the right patient is the right thing to do.  Also, attacking variability with blunt tools has negative consequences, much like using radiation and cytotoxic chemotherapy to fight cancer.   A better way to frame variability: there is good variability, acceptable variability and bad variability (normal, benign and malignant). We need to address the malignant variabilities with targeted and intelligent tools.