Visionary leadership

ThewayforwardforUShealthcare

ExpertsdrawtheirconclusionsontheAmericanhealth systemandwhatneedstobe donetoeradicatethemanyproblemsthatcontinuetomanifest.

In arecentlypublishedbook,healthleadersDr. Denis CorteseandAntonyBellofferaradicaloverviewofthedissatisfactionofthe Americanhealthcarequagmireandenlistwayswhichwoulddissolve themanyproblemsthatexist.

Accordingtotheleaders,theAmerican healthcaredeliverysystemisbreakingandbeyondfixing. Intheirbooktheyexplainthatthe onlywayoutof thisquandary isleadershipitself.Thebooktitled "Rescuing  healthcare:Aleadershipprescriptionto make healthcarewhatweallwantitto be,"was releasedin2017 andexplainsthemainwaysthe healthcaresystemissoflawed;somuch sothat itiscommonlyfoughtoverby politicians,debated endlesslybypeoplealloverthecountryandyetno realchangesareenacted.

Cortese,aFoundationprofessoratArizona State Universityand  formerpresident and CEO  ofthe Mayo Clinic,andBell,CEOofLeaderDevelopment Inc.,afirmthat helpsleadersinseveralsectors transformtheirorganisation,believethattheonly way forthehealthcaresystemto getbackontrack andprovidequality careatareasonable cost,isfor medicalpractitionersto beempowered.Thiswill allowthem tocreatemeaningfulchangeforboth thesystemandwhatmattersthemost:patients.

In a recent interview, Dr. Cortese and Antony Bell speaktoHealthManagement.org about theirbookandwhatvisionaryleadershipmeans to them.

Whatelseisneededfromseniorpoliticiansin ordertoimprovethe healthcaresystemwithin theU.S?

A clearvisionforwhattheywantoutofhealthcare. 100% coverageisneeded; high-value healthcare delivery;alearningorganisationforhealthcarein theUSA (sothateveryoneinthehealthcaresystem knowswhat thesystemknows);andiftheywant highvaluecare theyshouldhavesystemsofpaymentsthatarerelated tohighvalue–notfeefor service.

For example:“Insuranceforall”shouldmean thatallUScitizensareinthe sameprogramme. Thiscouldmeanasinglegovernmentpayersuch asMedicareoritcanmeanthat theUScitizensget thesameinsurance programme that allourFederal employees and politicians have - the Federal employees benefit plan. This is agovernment-regulatedprogramme;withfinancialassistancefrom the governmentforthose whoneed it;andfreedom  of multipleinsurance privateplans.Leadershipmeans leading–andthismeansthatEVERYONEisinthe sameinsuranceprogrammetogether.

Whatdoesitmeanto  beasuccessfulleader today?

Letussummarisekey pointsfromourbook(Rescuinghealthcare:aleadershipprescriptiontomake healthcarewhatweallwantittobe)asfollows:

a.  personal traits –highmoral andethical character;leadershipcompetence. One withouttheother willfail.Unfortunately,wehavelittleofbothtoday intheleaderswehearmostabout

b.  skillsinatleastthreedomains  ofleadership:
organisational leadership skills –create visions and  direction; sell and communicatethevision; aligntheorganisation;selectpeopleanddelegate responsibilities

operationalleadershipskills–planning,organising, measuring,settinggoals,settingincentives
people skills: selecting and matching the  right people;explainingandclarifying;motivatingand developingpeople

c.dealing withseveral elementsofleadership simultaneouslyandover time.Sharedvision;shared reality; strategy; tactics; culture andalignment; skills ofthestaff;technology;implementation.

How is this "shared vision" to be implemented?

Inthefieldof healthcare,the“organisational”leader willneed toworkwithasmallgroupofkeyleaders to successfullydevelopavisionthattheywillall support.Ofcoursetheorganisationalleaderwillplay amajorroleinthe visionbuthastobeprepared to modifypreconceivedideas as the team develops ideas that areevenbetterandmoreappropriate. Oncethevisionisclarifiedthehardworkbegins –relentlesscommunicationtoallthestaff andall theemployees.Thecommunicationneedstobe repeatedasoften asneeded andinasmanysettingsaspossibleuntilthe employeesandprofessionalstaffbegintothinkthatthevisionwasall theiridea.

How do you think this vision differs from otherhealthcaresystemsaround  theworld, aside fromitbeing apay-for-servicesystem?
Thevisionof highvaluehealthcare–bestoutcomes, highestsafety,bestservice andat lowestcostsis the visionforhealthcareinthe world.Andithasto beaccompaniedbyapaymentsystemthat keeps thebestprovidersinbusiness.Itisveryunlikelythat atraditionalfeeforservicesystem willeveraccomplishthat goal.NewmodelsofpaymentintheUSAmight,such as:bundledpayments,capitation,or providersowingtheirownhealthinsuranceplans.

Do you think there is a serious issue of burnoutamongstUShealthcarestaff?

Yes,indeed.  Allthesocalledstakeholdersinthe USAhavefoundwaystoreducetheiradministrative workloads,andsellmoreof theirproducts byshiftingall responsibility andaccountability toproviders. Who,overtime,havebecomeoverburdened with required orregulatedactivitiesthathavenothing to dowithdirectpatientcare.Whowouldn’texperienceburnout?

In order for healthcare to be financially sustainable, what are the most important factorsthat  comeinto play?

Torelentlesslyseekoutthehighestvaluecareand reimbursethoseprovidersinsuch awaythatthey can  remain  inbusiness.Forinstance:use reality pricingbasedontheveryhighestqualityproviders whoareabletokeeptheircostsdown.Thenpay insuch  awaythattheycancovertheircostsand accomplisha2-4% profit.Evennon-profitsmust makesome moneytoremainin business,innovate, replenish/replacetheirfacilities. Anewregulatory mindsethas  tocome  intobeing,such as wesee inregulatedutilitiesthat provideacriticalsocietal need  (electricity,water,etc.).