December 11 and 12 marked the annual meeting of trustees of hospitals throughout New England in Boston at the New England Healthcare Assembly. Usually the attendees at these meetings are there to get updated on new ideas in hospital governance and the functions of trustees within hospital organizations. As you might imagine, this is not a group of people who see themselves as rabble rousers, and typically there is little incentive to circumvent the party line of the American Hospital Association. The AHA in turn has been closely tied to insurance companies in the United States, opposing any health care reform which poses a threat to the survival or autonomy of traditional insurance. So you might expect that the trustees attending this meeting would favor an approach to health care reform that followed the direction of the AHA. My sense of the will of the trustees that I spoke with was that many are willing to take action that is far more radical.
This diary is written to give you the flavor of the information that was imparted at this meeting, and to suggest some ways to amplify the volume of the grassroots push towards meaningful healthcare reform.
The New England Healthcare Assembly Trustee Conference
I. Presentations
There were two presentations made to the entire group of trustees present at this conference that created a stir among the assembled trustees. The first hint that this meeting was going to shake things up came with the keynote presentation from Dr. Richard Chait, from the Harvard University Graduate School of Education. Dr. Chait presented an argument that trustees of hospitals (as well as other organizations) spend far too much of their time pursuing the goals of fiduciary responsibility and strategic planning. Dr. Chait argued that while these responsibilites were important, they did not include the essential role of creative leadership. He presented the notion that this restricted Boards of Trustees to working in tightly confining roles of problem solving that are largely technical in their leadership, and that this approach gives credence to assumptions about the nature of problems that Boards need to solve that are untested assumptions, and may in fact be false. Dr. Chait made the case that Boards should be spending far more of their time and mental efforts in an activity he termed Generative Thinking, a concept which is strongly suggestive of the Adaptive Leadership concept proposed by Ron Heifetz in his excellent book Leadership Without Easy Answers. In proposing that Boards learn to add Generative Thinking to their functions, Dr. Chait set the stage for trustees to begin to ask questions that threatened traditions that anchor the status quo of health care delivery.
Dr. Chait's presentation started the conversation simmering among the trustees. The second presentation by Mac McCrary brought things to a boil. Mr. McCrary's talk addressed emerging trends in American healthcare. He cited the unustainable rates of increase in the costs of healthcare nationwide, and the contribution of these rates to the current economic crisis. He discussed the irrefutable data that outcomes are worsening compared with other countries that spend far less on healthcare. He presented data on the growing data that healthcare expenditures are outstripping family budgets for housing, food, and clothing. He pointed out that the imminent demise of Medicare would have a profound impact on every other part of the healthcare system. And he highlighted the fact that healthcare systems in India, Thailand, and other countries were successfully competing for American patients in a way that was likely to have major impacts on survival for many American institutions (e.g. 6 million Americans are expected to seek elective treatment abroad by 2010). As you might guess, these factors did a lot to turn up the heat in the discussions.
II. Conversations
During conversations that occurred after the presentations, it was evident that many trustees felt some urgency about pushing a more aggressive healthcare reform agenda. The frustrating and oppositional approach of the Bush agenda is approaching an end, and trustees are looking for ways to have their voices heard, and to see the institutions they are volunteering so much of their time for kept intact. They are also looking for new and creative roles that hospitals can play as health care reform unfolds. Many are wary however, that opening the door to change risks having their hospitals become victims or scapegoats in the process. And everyone is scared of change. As much as Obama swept into office on the promise of change, it remains a truism that people only overcome the fear of change when it is exceeded by the fear of the status quo.
III. Potential next steps in the conversation
Change we must. Too long we have clung to ways that do not work, can not work. A cogent argument can be made that at least part of the current economic crisis can be attributed to the disproportionate share of the economy that health care consumes. Barack Obama has wisely recognized that the change we need cannot come from the top down. The lessons of the Clinton's ill-fated attempts at health care reform remain poignant and fresh. Until and unless there is readiness, indeed demand for change, imposing it from the top down is likely to be a fool's errand. Real, productive change must come with the adaptations and changes in values that we must all engage in. What Obama's administration signals is a way to facilitate that change, to permit it to happen, to support and guide it in a way that leads us out of our current crisis of confidence. In the end, it is up to all of us to find a way to come together to make the change we need in the delivery of healthcare in our society. I believe that the conversations I witnessed in Boston last week are signs of opportunity for this change. The emergence of recognition of the urgency of our need in those responsible for the continued integrity of the social institutions in our communities is a chance for momentum to gather and grow. How this will unfold is difficult to predict. But here are a few things we can all do to have our voices be amplified and heard.
I recommend that each of us seek out and engage in dialog with hosptial trustees in our home communities. Ask them what they fear and what they need to keep their hospitals open and functioning. Engage them in a discussion about what kinds of change will best serve the members of your community. Make sure they are aware of the opportunity that the new Obama administration represents, and help them engage the whole community in a dialog about what health care needs to be. Help them understand how to get input into the process. In particular, I believe that it is essential to address issues of trust, transparency, and accountability that are preconditions to acceptance of any change in the health care delivery system. Ignoring these changes will foster suspicion, and gives ammunition to opponents of change to instill vague fears that are counter-productive.
I also recommend that you bring local legislators into the discussion with trustees. The economic reality of the current economic crisis have imposed tremendous pressures on state legislators. To the degree that change represents possible solutions rather than added problems, legislators may also be ripe to accepting creative change as part of their responsibility.
Hospital trustees are a wonderful, hard working resource in every community. They have insight and connectedness to vital institutions within these communities. This is a chance to galvanize this resource into an instrument to promote real change.
Change has been enabled. It will only become reality if we all learn to engage in solving our collective problem. This engagement is not a simple, momentary effort. Rather, it will take sustained effort and ongoing dialog, openness, compromise, and commitment. I think that the stakes are too high to let this opportunity slip by. I look forward to hearing input from other members of the dkos community.