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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…
3
How it really is…
5
Change
6
L = Vision + Task + Relationship
7
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
10
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50
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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
1000
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1000
30
1000
20
1000
10
= 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.
34
Six Ways to Build Leadership
35
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