Crises, Catastrophes: Times for Learning?

In early October, an online search showed about 390 million results were found on Google in 0.39 seconds for “crisis management plan,” about 14.7 million results were found in 0.38 seconds for “catastrophe management plan” and about 173 million results in 0.66 seconds for “disaster management plan.” Clearly, any attempt to academically review greater than a half-billion results to learn something more would be catastrophic in itself. I needed another path.

Most of us have been aware of disaster planning efforts for our medical facilities and within our office environments. We might even have something organized for our homes and families. At AAPL, we have a well-articulated plan of action should some disaster affect our operations. And yet most of us also are aware of how imperfect those plans are and how poorly they might reflect the reality of any particular situation. Rehearsal and practicing help modulate those potential nuances, but every situation is different. For instance, just consider how we all react whenever the darned fire alarm happens in our workplaces.

I am not going to take on the debate as to whether health care is in crisis mode — everyone is entitled to their opinions and viewpoints. I will state again, however, that health care is an inherently complex industry and so it is easy for both optimistic and pessimistic viewpoints to emerge. Optimism tends to bring views for opportunity, while pessimism can bring views toward protectionism (also debatable). This complexity is an opportunity for physician leadership and our profession to emerge continuously as a significantly important influence for the industry to follow. The industry precedent is in place, and expectations for physicians to lead remains strong at multiple levels in our societies. In fact, physician leadership is now a strong market demand in many environments and communities as it relates to health care delivery.

Learning Happens Everywhere

As a recent business school guest lecturer, I was privileged to present the topic of physician leadership to a crowd of more than 200 graduate students and faculty from nonclinical disciplines related to health care (MHA, MPH, etc.). Looking out from the lectern, it was obvious even before I got into the message of my presentation that I was being held in high regard just because they knew I was a physician who had embraced leadership as a career path — humbling, for sure. The lecture went fine, the questions were poignant and the swarm after the talk was gratifying. But my ego aside, the real learning moment for me — not them — was in watching their enthusiasm to engage in our industry and their energy for wanting to help create further change in this complex set of systems. I left the event feeling optimistic about their futures, and ours as physicians, that we have a fresh generation coming into the field, and that their impact soon will be felt.

We already know that those entering medical school and residency programs continue to carry high levels of altruism and idealism. They, too, are driven to create change and, as best possible, to make improvements beyond simple patient care. So, if there is any form of crisis pending out there, it might be one where we, who are already in the workforce, are not effectively laying the groundwork for younger generations to more easily and readily succeed as they make their presence felt in the workforce. It is a necessity that we learn how to avert this form of a crisis so that our industry, our future peers and our patients all can benefit from the effects of these individuals as well.

Let’s pay attention — the younger generation has much to teach, and we all have much to learn from up-and-coming clinicians and other affiliated health care disciplines. Interprofessional approaches will only grow.

An Industry Crisis

A crisis in workforce wellness also is present in our industry, and it is present within all disciplines — clinical and nonclinical. Our workforces are getting worn out with this industry’s complexity and the difficulties with creating change in its systems. One easily can list all the changes needed and areas where innovation is required, but this will continue to take some time. For example, the current era of patient safety and quality is nearing 20 years — have we made significant change in these areas? That, too, is debatable, but our workforces are getting tired in their efforts to keep making necessary changes. Large-scale industry change typically takes three to four generations of time.

So what can we collectively learn?

I would advocate more simplicity, not more complexity, in the varying approaches to systems re-engineering. There already is a robust science out there we need to embrace. We also need to further embrace the science for human-factors engineering to create significant change and to also incorporate the evolving science of behavioral decision-making in our efforts. These are only a couple of example areas, and I recognize it is far too easy to state their need versus actually implementing projects in this regard. Nonetheless, there is much to learn from these disciplines that we should consider integrating within health care.

Financial reform and realignment is another area where we can create learning opportunity. Finances drive the entire system, by necessity. Fortunately, payers in both the for-profit and public sectors are making strident efforts toward value-based care and payment. Once more, however, I would advocate for increased simplicity with the large number of financial models being trialed by various organizations. Let’s learn to walk before we run with value-based care strategies and financial reform. That does not mean go slowly; it just means we should try to make success occur with simpler solutions that can be replicated before we advocate for the widespread, multiple pathways or experimental models. (Both payers are guilty of these approaches.) Shotgun strategies only serve to confuse the marketplace and also creates the risk for profiteering.

The Association’s Role

Leading change is the association’s overall intent, by helping to create significant change in health care through the platform of physician leadership. I strongly believe we are not only ahead of the curve, but, in some ways, we are actually setting the pace for our industry. We are optimistic about the industry, and we see nothing but opportunity for creating positive change. AAPL heavily promotes the message that, at some level, all physicians are leaders. At its core, AAPL maximizes the potential of physician leadership to create significant personal and organizational transformation.

I encourage all of us to continue seeking deeper levels of optimism and to generate positive influence at all levels to which we are individually comfortable. As physician leaders, let us get more engaged, stay engaged and help others to become engaged. Creating a broader level of positive change in health care — and society — is within our reach.

And as we continue to make change in health care, let us not forget about the many individuals and communities who have been, and who will in the future be, affected by crises or catastrophes. At their core, all physicians are caring, compassionate people who care deeply about others. Let your own altruism and idealism surface so that others are aware all around you, so that you can help others in their moments of need during difficult times. It is what we do — it is our calling to help and care for others that benefits society.