How the Seeds of Culture and Relationship Dynamics from Fifty Years Ago Effects Health Care Today

I was recently having a conversation with a leader of a nonprofit organization about their strategic planning process.  Nonprofits have an additional facet of execution for profits rarely have to consider; the payer of the services provided is typically not the one who is receiving the services.  Not only must a nonprofit secure funding, but then they must conduct outreach to recruit the population they wish to serve and only then can they actually execute on the delivery of their mission.  Perhaps the only for profit business models that are similar are auto body repair shops and human body repair shops, or in other words, our health care system.

That got me to thinking, why is our health care delivery system so disjointed, and at times, remarkably out-of-step with more modern approaches to leadership, strategy, and organizational development?  This is a sector I’ve worked in for more than twenty years, so I have a fairly long perspective of how things have evolved over time.  Two months ago I wrote a blog entitled, “Signs Health Care Needs to Transform Before it can Reform“, in which I explored some of the patient hand-offs, disconnects and complexities of today’s health care continuum.  But that blog explored where we are and what we need to do, at a very fundamental level, to transform leaderships’ approach to delivering health care services in the face of reform.  What it didn’t fully explore was the root cause of this discontinuity and the peculiar provider/patient/third-party payer dance we witness every day.

I have a hypothesis as to what may have set us on the course we’re mired in today.  It has to do with the historical relationship dynamics that emerged between doctors and patients.  In every other economic exchange, the balance of power in the relationship tilts towards the consumer.  The customer holds sway.  Traditionally, this hasn’t been the case in health care.  The doctor was the authority and held domain over the relationship.  People of my parents’ generation simply didn’t question doctor’s orders.   In what other industry does the seller of a service dictate the relational dynamics between provider and consumer?

While this may seem subtle, I believe it may be at the root of the dysfunction we see today.  I invite you to take a look at some of the research I uncovered in the blog I refer to above and see if you come to a similar diagnosis.  The key facts that jump off the page to me are a lack of self-awareness on the part of many health care providers.  The research indicated a prevalent attitude that, “Yes, health care is broken, but not at our hospital or in our practice.  We’re just fine.”  This hidden blind spot, that everyone else is the problem, not us, has engrained over time.  If you have all the power in a relationship, and have no intention of relinquishing that power, you will rarely be held accountable for your behavior or attitudes.  Relationships, on all sides, become dictatorial rather than cooperative and co-creative.  Communication erodes, medical errors occur, nurses are abused and burned out, and adverse events go unreported (the Department of Health and Human Services recently discovered 7 out of 8 adverse events are not being reported as mandated by law).

Exacerbating this relationship-based imbalance is the third-party payers’ role in our system.  Consumer behavior in a typical marketplace sets the competitive tone of the market.  Firms working in that marketplace respond to both the consumers’ demands and competitive pressures.  Yet in health care, the role of third-party payers (i.e. Medicare, Medicaid and the insurance companies) sets the reimbursement levels for services.  This has followed a downward spiral of reimbursement cuts for procedures that has led to doctors doubling the size of their patient load in order to maintain their overhead, staff, and income.  As a result, physicians have even less time to establish authentic relationships with their patents.

Until we address the causal effects of what brought us to where we are today, any efforts to improve the quality of care and efficiency of delivery will only be treating the symptoms, not the disease.

© 2012, Terry Murray.

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