LEADERSHIP SOLUTIONS TO HEALTH CARE PROBLEMS
Bernard J. Healey
After reading this chapter you should be able to
• Describe the development of organizational conflict in health services delivery.
• Understand how leadership skills can help health care administrators meet the many challenges facing the U.S. health care industry.
• Identify ways in which the structure of a health care facility can block necessary change.
• Understand how creativity and innovation can develop in health care facilities.
During a crisis the United States has in the past always been able to find leaders who come to the rescue and make things right. Unfortunately, with the massive change and resulting turmoil in our health care delivery system in recent years, there seems to be a shortage of real leadership to make quality health care equitable for all people.
One of the most difficult concepts for most individuals and institutions to understand and embrace is the need for constant change. Their argument is always that there is no need for change if, to their minds, everything is working well. In fact most people will use whatever personal and collective power they have to block change if it affects them in anyway, owing to their fear of the unknown. They are incapable of seeing the opportunities that may result as a consequence of change. Health care organizations are no exception; they do not want to change.
Despite this reluctance to change there are numerous indications that the pace of change in our world is accelerating at a remarkable pace. There are many reasons for the escalation of change in our lives and businesses over the past twenty to thirty years, with improved communication being found at the top of the list of change process facilitators.
Understanding why change occurs is important, but not as important as gaining awareness of the fact that our individual and collective futures rely on how we accept change, adapt to change, and even play a part in creating change. It is no longer acceptable for individuals or businesses to simply react to change; instead they must become proactive in and be part of the creation of change. If an organization wants to remain relevant in the long term, it must actually seek out change and exploit that change for the opportunities it may offer. This is true for health care delivered by providers and received by consumers. The health care sector is ripe for change and the innovation in health care services that it may bring.
Serota (2013) argues that a major barrier to an improved system of health care in the United States is the fragmentation among the many players, resulting in a lack of coordination in care delivery. The Patient Protection and Affordable Care Act pays little attention to the financing of health care and virtually ignores the idea of designing financial incentives that would improve the delivery of health care services. However, health care reform should include financial incentives that are designed to allow cooperation between payers and providers of care to improve the quality of care and health outcomes. If we carefully craft these financial payments to improve health, rather than simply provide expensive and unnecessary services, we can eliminate a great deal of the current waste found in our health care delivery system. It is hard to understand why the designers of the Affordable Care Act ignored how and why we pay providers of health care services.
The United States has created a complex health care delivery system that is difficult for the average individual to understand. Perednia (2011) nevertheless argues that even though our health care system is extremely complex and dysfunctional, it can be understood if we spend some time dissecting the various incentives that guide its operation. In fact Christensen, Grossman, and Hwang (2009) state that the major problems facing the health care sector of our economy are not unique but are instead similar to the problems faced by many other large industries. At some point in their history, large industries that sell expensive products and services are transformed into making more affordable products and services, which then become available to more people. The agent of this transformation has been labeled disruptive innovation. Christensen and colleagues believe that this disruptive innovation is slowly presenting itself in all service industries, including education and health care delivery. This disruption will, over time, produce great change in the way business is done and services are delivered to patients who are evolving into consumers as they are becoming responsible for a larger portion of the costs. One of the most important components of this disruptive innovation is found in the concept of the value-adding business process. This process of adding value to the product or service offered to consumers requires a reduction in price or an increase in the quality of the final offering by the business.
A new product or service that is capable of changing an existing market by improving convenience, access, and/or affordability.
value-adding business process
A new business process that increases the value of the current product or service.
The value-adding business process has been virtually missing in our health care organizations. In fact, for most health care facilities, adding value has usually been defined as adding more activities in order to increase the revenue stream for the health care provider. Unfortunately, many of these activities that add value for the provider offer little if any added value for the patient while at the same time increasing the cost of health care services and at times actually placing the patient in harm's way. A true value-added component would add real value as perceived by the customer.
Disruption is occurring in every business in the world, even health care delivery systems, whether they are private or government rim. The U.S. health care delivery sector is also facing radical change, but who will lead that change? We need new leaders to repair our health service delivery system. In fact lack of leadership is probably the major reason that health care has had so little success in meeting recent challenges. Our health care sector is reluctantly moving to an understanding that bureaucratic organizations and poor leadership are the real cause of the system's failures in delivering quality health care services at a reasonable price.
In order for health care facilities to remain relevant they must develop and share a vision of the future that is acceptable to all their stakeholders. Although the final direction of an organization is the responsibility of its leaders, the change in direction must be a collaborative effort of the entire health care organization, including the consumers of its service.