Decisions and Dollars: The Call for Physician Stewardship

Why greater value in health care is every physician’s responsibility.

Part I: Talking to physicians: how we do vs. how

we should 2

Schematic of American economy

Health care cost is consuming the American economy.

The rational response to fires

National coordinated effort to rationalize and optimize efficiency and efficacy

The all too human response

We’ve known how to spray each other for years, and we’re good at it

Spraying each other is familiar and comfortable, albeit unpleasant

We don’t know how to fight fires

Fighting fires is the unknown

It’s not a math problem. It’s a sociology problem.

We don’t make decisions about important stuff the way we think we do

We don’t like each other much, from decades of spraying each other

We don’t understand that those wet people over there are now essential to us winning the game

How we thought we make decisions, circa 1980

Thought enters our consciousness

Make rational assessment

Make decision

Have feelings about decision

How we actually make decisions

Brain perceives input in limbic system (responsible for fight or flight)

Brain decides on necessary action

Feet already moving

Input reaches cortex, where we make up reason why our feet are already moving

And so we prefer the painful familiar to the unknown

If only we could start with a blank slate. But instead…

Decades of fighting over money

Siloed bottom lines purposed to perpetuating siloed bottom lines

“Somebody has to do something, and it's just incredibly pathetic that it has to be us.”

Jerry Garcia, Grateful Dead

“Ask not what your country can do for you, ask what you can do for your country.”

John F. Kennedy, POTUS

BUT CHANGE IS INEVITABLE. HERE’S WHY.

12

The three tsunamis that are reshaping everything (not just medicine).

13

The first tsunami: red ink

HC 6% of GDP in 1960, 17% in 2013

HC eats up nearly all productivity gains in the 2000s

The second tsunami: information

Moore’s Law

Big data emerges in health care

Watson goes to medical school

The third tsunami: the empowered individual

Individuals take on more financial responsibility

Web decreases information asymmetry

Consumer Reports comes to health care--literally

T H E G A M E H A S C H A N G E D . T H O S E W E U S E D T O F I G H T W I T H A R E N O W E S S E N T I A L T O

O U R S U C C E S S .

17

Something has to give.

The making of a new social contract

Old quid pro quo

Infinite power for infinite responsibility

Lack of data to measure performance so use of outlier whack-a-mole as regulatory mechanism

Guilt, fear, and shame as cultural regulatory mechanisms

New quid pro quo

Contributing expertise within a shared responsibility

Big data measures everything

Team performance outweighs individual performance

18

Part 5: Change management theory

Collins: level 5 leadership and ROI loops

Kubler-Ross stages of grief

Incentives: Financial, social, and ethical

Kotter: Why transformation fails

Jay’s theories: the scars on the back of his head

19

Incentives: the three big buckets 20

Part 6: Take home messages 21

Make no mistake, the task before you is enormous

Change is about feeling more than thinking

Changing physician culture is a particular challenge given our selection and training

Part 6: Take home messages 22

The three Ds make change inevitable

It will take integrity, courage, and persistence for physicians to lead their peers to a better place

The question to ask: “Will you help us, and each other?”

The greatest consistent damage to businesses and their owners is the result, not of bad management, but the failure, sometimes willful, to confront reality.—Larry Bossidy and Ram Charan, Execution