Having been out of training and working in the real world of academic health care for only 16 years, I hesitate to make judgments or conclusions. Instead I make hypotheses or formulate theories. Having only 24 hours in a day, I can’t test every hypothesis. Thus, I have presuppositions.  My three presuppositions below describe the enemies of transformation, the secret weapon of trust and the means to acquire it

The first presupposition is that we have four enemies in health care: Hubris, Cacoethes Carpendi, Seorsum and Avaritia. Hubris speaks to the collective and individual excessive confidence and arrogance that is prevalent among health care professionals and organizations. Cacoethes Caprendi means compulsive habit for finding fault, which refers to the blaming culture that can be found in health care organizations with regularity. Seorsum means apart or not together, referring to the lack of alignment and the inability to integrate varied self-interests into shared goals and values, and (most importantly) shared expectations of behaviors and results. Avaritia is latin for greed. Greed is the elephant in the room no one seems to want to address (not addressing it may lead to it devouring us). Some don’t see these four as enemies, and some don’t see they exist in the first place.   There is variable penetration to be sure, but they are there.

The second presupposition is that trust is lacking in health care organizations today, which makes everything from timely decision-making to efficient and effective teamwork elusive. Have a vision? Great! Have a strategy? Good for you! Have an execution plan?   Wow, impressive! Have trust in your organization? No? Then forget it.  The lack of trust hypothesis is harder to test, because trust lies under the surface. I’m convinced it’s a real problem. Those organizations that work on building a trust culture will adapt to external forces of change faster and more successfully. Trust is the secret sauce or weapon (I prefer the weapon metaphor when it comes to fighting enemies).

The third presupposition is that leadership in health care is lacking capacity.  I attribute this to my Intelligence-Ego Ratio theory.  An individual’s leadership is more effective if their intelligence is greater than their ego.  The optimal ratio is 2-3 (2-3 times more intelligence than ego). It’s counter-productive in the long-run to be <2.   One with a ratio of <2 may get placed into a leadership position.  However,  the organization’s success will have a ceiling.   One with a ratio of >3 will find it hard to get recognized as a leader, but long-term success is more likely.   This theory essentially states that intelligence is incredibly important, but if you let your ego trump your intelligence, you’ll eventually look like an idiot.  Humility is key to being the best leader one can be.  It drives a desire to continuously improve every day.  It allows you to be more open to learning from mistakes or miscues.  It allows you to build trust.

Intelligence doesn’t just mean mental capacity or complex problem-solving abilities. It also means the insatiable desire to learn and continuously fill the head with data, information and experiences (not just your own).  It also refers to emotional intelligence, the capacity to understand where you are and where others are with regards to relationships; relationships with self, others, the organization and society.  Intelligence essentially refers to the capacity to expand your awareness and perspective larger than anyone else around you.

So, what do we do about these presuppositions?  Take the following steps: 1) Increase awareness regarding the enemies, the secret weapon of trust, and the importance of the right leadership, 2) Embrace humility as organizations and as leaders, 3) Be resolved to succeed, persevere and do the right things, 4) Accept the need to change, 5) Drive change through continuous improvement, 6) Have relentless focus on mission, vision, values and principles, and  7) Get results on the most important shared goals.  If you aren’t getting the right results, then go back to 1 and start over.