According to Adaptive Leadership theory, there are two types of challenges, technical and adaptive.  Currently we’re facing multiple adaptive challenges in pediatric healthcare.  Complexity, both diagnostic and therapeutic, is increasing.  Expectations, good, bad, and indifferent, of both the consumers and the payers are not only shifting and expanding but increasing in intensity.  Advancements in technology, data analytics, and artificial intelligence are increasingly impacting our business.  Disrupting ways to deliver health care are threatening our current business models.  The economics of health care delivery are evolving into an impossible calculus for these current business models as well.  And most importantly the workforce has irreversibly changed in capacity, context, complement and culture.

Technical challenges can be addressed with known methods and tools.  Adaptive challenges require developing new methods, tools, and systems.  This implies the need for change and innovation while doing the daily work.  Missteps are likely to occur; disruption is inevitable.  PDSAs can be rewarding.  Yet, PDSAs in the middle of an already overwhelming workload, especially if the learning includes what doesn’t work, can be demoralizing and disengaging.  Messiness, failed experiments, change that is hard, and learning new ways of doing things are often unwelcome in the workplace.  Perhaps the biggest challenge is just finding the time to do the work that innovation, experimentation, collaboration, and learning takes.

One risk of not meeting these adaptive challenges is a decline in pediatric health outcomes.  As the larger system evolves out of forces not necessarily aligned with the needs of children, we may see outcomes worsen before they start improving.  Families will opt for convenience unaware of the risks.  New entrants will claim excellence and deliver something else.  Web based services, including AI, will be advertised as a better option, but not be.  I assert there is an urgency to addressing the adaptive challenges facing the pediatric healthcare system.  Addressing adaptive challenges starts with changing how we see things and how we think.  One of those paradigm shifts is looking at how we’re doing through a value perspective.  Value is better outcomes with minimal waste.  Value is deploying resources and getting meaningful, measurable output, and the most important outputs in health care are patient-(& family-) related outcomes.  Process metrics can be good surrogates for outcomes if we measure both, check our assumptions, and connect the dots.