Sunday, September 5, 2010

Health Reform, Democracy, Leadership, and Innovation as General Propositions

I dare say I have worked off my fundamental formula on you that the chief end of many is to frame general propositions and that no general proposition is worth a damn.

Oliver Wendell Holmes, Jr. 1841-1935

For we physicians, health reform, democracy, leadership, and innovation are general propositions.

We believe deeply in all of these things, but they can be messy generalizations.

We believe in health reform in general, but not in some of the particulars of the present reform law.

We believe in democracy, but in our organizations, democracy is sometimes one of our weaknesses. The AMA is one of the most democratic organizations on the planet in which everyone can have their say. Group medical practices are democratic because every physician within any given practice generally has veto power when it comes to altering the status quo.

Physicians all have the same rites of passage – pre-med, medical school, residency, the Hippocratic Oath. We tend to think all physicians put their pants in the same way. We don’t necessarily trust hierarchies with other physicians at the top.

This can make leadership difficult. How much we trust our leaders depends on what faction of the profession they are leading and on where they stand on certain issues.

Dr. Donald Berwick is a leader, but he leads the pro-government forces. AMA presidents, past and present, are leaders, but they tend to defend the status quo or promise too much to too many. Dr. Daniel Palestrant. CEO of Sermo, Inc, the 115,000 online physician community, is a leader but he leads the reactionary forces, which an anti-AMA and anti-government.

In 2009, to help bridge physician leadership gaps between factions, the Physicians Foundation, representing physicians in state medical societies across the land, established the Physician Leadership Academy at the Kellogg School of Management at Northwestern University.

The Academy provides an intensive three day certification program for physicians in leadership roles within their state medical societies. The foundation will issue and fund grants for innovative programs that address the needs of patients and physicians and that improve care.

Which brings me to the messy and seductive subject of innovation. America prides itself on being an innovative society, and for developing innovative solutions, generally technological, for disease ills and health care’s social ills.

But curing these ills transcend the technological. They involve organizational, cultural, behavioral, and ideological changes. These do not come easily – and they come slowly.

For, while many Americans desire change, like the desire for more affordable care, most desires remain constant, like the desire for freedom of choice, the desire for access to the best medicine has to offer, physicians’ desire to exercise their clinical judgment in the best interests of patients, and patients’ desire to retain their present benefits.

Successful innovation is, by its very nature, messy. Innovation across boundaries requires trade-offs, and collaborative cooperation addressing problems, opportunities, and complex interconnections in innovation-rich communities and environments, like Silicon Valley.

Two new books on innovation capture the essence of this messiness.

• In “The Innovator’s Way: Essential Practices for Successful Innovation” (Massachusetts Institute of Technology, $29.95), Peter J. Denning , a professor at the Naval Postgraduate School and Robert Dunham, a consultant and former executive, approach innovation from the traditional perspective of individual and group action. Mr. Denning, a professor at the Naval Postgraduate School, and Mr. Durham, a consultant and former executive, lay out eight practices they deem vital to success: sensing, envisioning, offering, adopting, sustaining, executing, leading and embodying.

These practices require leadership of a high order.

• In the second book , Where Good Ideas Come From: A Natural History of Innovation” (Riverhead, $26.95), Steven Johnson, an expert of innovation, focuses “the space of innovation.” Mr. Johnson argues for environments — networks, physical spaces, cultivated behaviors — that “compulsively connect and remix that most valuable of resources: information.”

These spaces require both order and chaos, the presence of which allows ideas to emerge, collide, recombine and, above all, be broadly shared.

Perhaps the Physicians Foundation is its Leadership Academy at Northwestern will be able to provide a space for innovation and for the collision and recombination of ideas.

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