Health Care Reform: Five Miles Gone…A Long Way Home

Edward O’Neil, PhD, MPA, FAAN

O’Neil & Associates

How we wish we could lead change…

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How it really is…

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Change

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L = Vision + Task + Relationship

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Level Set: Three Drivers

•US spends 1/3 more

Why can’t we change?

Big Challenge

Transition

Today

• Acute treatment

• Pay for transactions

• Cost unaware

• Professional prerogative

• In-patient

• Individual profession

• Traditional practice

• Information as record

• Patient passivity

PPACAHCERA

Tomorrow• Chronic prevention and

management

• Pay for value

• Price competitive

• Consumer responsive

• Ambulatory – Home and Community

• Team

• Evidence based practice

• Information as tool

• Consumer engagement and accountability

Market

Strategic Success

US Health Care: Four Options

•Drive it less- ration

•Shift the costs

•Pay less for it- controls

•Build a new chassis • Expensive• Overbuilt• Underperforming

Human Cussedness

Paradigms

• Effective tools

• Make things work

• Provide coherence

• Eventually, limit what we think we can do

• Eventually stops working 0

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Inputs

Pro

duct

ivit

y

The Paradigm and Benefits of the SQ

Health Professional work has provided:

•Worthy, fulfilling work•Social meaning•High social status•Prestige•Independence•Good Incomes

And, at its very heart,

Meaning,Self-definition and Identity

Add These Numbers

Add These Numbers 1000

Add These Numbers

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Add These Numbers

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Add These Numbers 1000

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Add These Numbers 1000

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Add These Numbers 1000

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Add These Numbers 1000

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Add These Numbers 1000

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Add These Numbers

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= 4100

What is a New Practice Model?

What Changed?•Professional role•Management of information•Sequencing of care•Engagement of consumer•Engagement of community•Practice model•Business model

New Value Proposition Created

New Practice Models Need Seven Things

• Systems Integration (> 7)

• Focus on patient/consumer (>6)

• Radical efficiencies in resource use (>4)

• Team based care (>6)

• Collaborative practice (>3)

• Community- Public engagement (>4)

• Integration of behavioral and physical (>5)

Why Are We Blind?

• Systems

• Consumer

• Efficient

• Teams

• Collaboration

• Public Health

• Behavioral

Abraham’s World and Its Problems

To Improve …

• Modern science

• Practice and research

• Autonomy

• State regulation

• Control by the profession

• Standard regulation

A Century Passes…

• Knowledge becomes siloed

• Consumer are isolated, ignored and powerless

• Professions become wholly autonomous

• System and incumbents become disengaged from general health and well being

• General wisdom gives way to specialized information

What would Abe see today?

• Shocking cost of care

• Knowledge that moves

• Consumer unrest

• Babel of our enterprise

• Unskilled professionals

• Fatal disconnect - professionals and the public

Nursing and the Transition

Problem

• Expensive

• Unionized

• Passive mentality

• Lack critical thinking

• Looming shortage

Solution

•Right skills

•Future oriented

•Patient focused

•Problem solver

•Institution based

or

Nursing leverages reform

• Quality Improved• Costs lowered • Consumers satisfied

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To See the Glass Half Full, ALL Nurses Must See Themselves as Leaders.

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Six Ways to Build Leadership

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Build from Core Competencies

– care management

– population - systems context

– teams

– psycho-social-behavioral

– service orientation

– use of resources

– adaptive and innovative

Work Across the Continuum of Care and Lead Where You Stand

Transitional Care

CommunityClinics

Beginning of Life

School Clinics

Healthy AgingWellness

CommunityChronic Care

Palliative Care

Focus on the Future

Stop Eating the Young

Perform

In the hospital:

• every nurse an agent of quality

• incentivize innovation, creativity and change

• make them smile, when they make them smile

• share the gains

Be Different

Follow These Leadership ABCs

• Bring coherence

• Lead up

• Assert your leadership through change

• Build leadership skills everywhere

• Expect leadership from every nurse

The Myth of Sisyphus

We tend to think of Sisyphus as a tragic hero, condemned by the gods to shoulder his rock sweatily up the mountain,and again up the mountain.

The truth is that Sisyphus is in love with the rock. He cherishes every roughness and every ounce of it. He talksto it, sings to it. It has become the mysterious Other. He even dreams of it as he sleepwalks upward. Life is unimaginable without it, looming always above him like a huge gray moon.

The Myth of Sisyphus

He doesn’t realize that at any moment is permitted to step aside, let the rock hurtle to the bottom, and go home.

Tragedy is the inertial force of the mind.

Stephen Mitchell, Parables and Portraits