Healthcare Change- Finding Common Ground
As recently as a month ago, we might have compiled the multiple healthcare reform bills in search of common themes to prepare for likely changes to come. Who would have supposed that successfully managing a health insurance organization would require that we become political pundits? As the conversation unfolds, its resemblance to a dialogue is quickly dissembling into a conflict based on the loudest and last word spoken rather than on the merits of any given proposal. Terms are morphing, healthcare reform is being recast as health insurance reform. Our industry had approached the table with significant contributions, including a willingness to forego benefit exclusions based on pre-existing conditions in the context of a marketplace where effectively all lives are health-insured. Health insurers are now being cast (by those who oppose reform) as the villain solely responsible for wasteful healthcare costs.
While we witness conflicts currently devolving into an argument that is becoming personal, it’s a good time to recall the hierarchy of conflict. Whether or not the nation can apply it to restore a healthy conversation on reform; I’ve witnessed many capsized ideas and projects where the failure of parties to engage productively had been misconstrued and escalated as personality conflicts when in fact the disagreements lay elsewhere.
When seeking common ground to achieve effective change, the groundwork needs to begin with common goals. Are we going North or are we going South? Healthcare reform goals that have been given a great deal of air time include: expanding health insurance coverage to a greater portion of the population; improving the quality of healthcare; reducing the costs of healthcare. In the case of the multiple healthcare goals, concurrent implementation seems contraindicative. Expansion of the number of people covered runs headlong into notions of reducing cost. Does improving quality also increase cost? If more people are covered, will quality of care suffer? The building blocks to meet these multiple, seemingly contradictory goals are the inter-related incentives and constraints of public and private funding, benefit and product design, marketing and sales, network design and management, medical management policies, and the costs and benefits of quality customer service. Without the foundation of an agreed-upon set of goals, no other conversation is productive or possible. While healthcare reform goal-themes we’ve heard are relatively finite and usually common, I suspect our national dialogue has not fully resolved the objectives that will find commitment from all parties. Where parties don’t recognize the goals are mis-aligned, the arguments may be misconstrued at a personal level. “They never listen,” “they don’t understand,” become common refrains.
Once goals are in alignment; proper planning addresses the strategies and tactics to achieve the goals. Even our agreement on compass heading will not stand in the face of our holding different ideas on the best approaches as to how to get there. In the case of healthcare costs, are they really attributable solely to any of: wasteful and redundant services and tests? Exorbitant case settlements driven by greedy lawyers? Imprudent use of expensive emergency room settings for routine care? Rising insurance premiums? When disagreements revolve around strategy and tactics, accusations degenerate to statements like, “They’re taking the wrong approach,” and “they have the wrong idea.”
If we can agree on the spectrum of strategies and activities to achieve our goals, then the next forward step depends on our agreement to engage in change within specific roles. I’m sure you’re familiar with the metaphors for these problems. “Nobody’s minding the store,” “Too many chefs,” are expressions relating to the absence or over-abundance of leadership providing vision, direction, encouragement, organization, and support. Complex change depends upon many roles, each played well, from leadership, project management, to the rank and file. The complexities of the inter-related component goals proposed for healthcare reform call for clearly defined responsibilities and roles. “They’re not doing their part,” “They’re trying to run my division,” “I don’t trust them,” will otherwise become commonly heard refrains.
The most unfortunate end-point for breakdowns in goals, strategies, and roles is the misperception that these failures are personal in nature. Nay-sayers and spoilers, without contributing thoughtful solutions, resort to personal insults and vindictiveness. Comments erode to, “They’re all idiots.” Truly personal conflicts are actually rare, if we take the time to seek the other hierarchical layers of conflict and commonality, we often find the root source of disagreements lies in misaligned goals, strategies, or roles.
With respect to accelerating your organization’s ability to respond to whatever changes may come: listen for conference room comments and water-cooler dialogue. They may provide clues as to where your projects are misaligned and off-track. Remember to begin alignment work from the top: Goals, Strategies, and Roles.
With respect to the national debate, insist and contribute to the dialogue at a more productive level. It will be our only hope to identify, design and accept desirable change, and to discern, honor, and retain aspects of healthcare services delivery and funding that work.
