Monthly Archives: November 2013

Its What’s at the End of the Patient Experience That Matters Most

We start with a hypothetical situation.  You have just been diagnosed with a serious but not urgent medical condition and have been given two options for care.

Option A involves a health care system in which the administration just launched a patient experience campaign of which they are very proud.  You call for an appointment and the phone picks up on the second ring.   A very bubbly receptionist schedules you for an appointment tomorrow.  You arrive in the office which has been meticulously designed and apportioned with the finest furniture.  Calm music plays in the background.  The atmosphere is relaxing.  You are promptly escorted back to an examination room and placed in a very comfortable gown.  You can’t help notice the great art on the walls and wonder how much this must have cost.  In walks your new doctor and right from the start your relaxed state begins to change.  He seems nervous, rushed and unprepared.  Really doesn’t listen much.  You never become engaged in a dialogue.  There is no education.  What you don’t know is that he has thrown up the white flag and surrendered to the corporate model of medicine years ago.  He just wants to see as many patients as he can today.  The other thing you don’t know is that he hasn’t picked up a book or read a journal article in years.  Maybe goes to a continuing education meeting a year in a nice resort town.

Option B is next.  You call for an appointment and the very polite office person tells you that the next opening is a  day next week.  When you show up the office is clean but a little dated.  No music or art.  As you are led into the examination room you begin to get a little anxious about the entire “feel” here so far.  In walks your new doctor.  The visit begins with an introduction and a few minutes of small talk.  The doctor does a lot of listening and you feel engaged in your care.  You get the feeling that this person is genuinely interested in helping you.  What you don’t know here is that this doctor has refused to give in to corporate medicine model.  Even more importantly, this doctor realizes that knowledge is the foundation of quality health care.  He spends at least 2-4 hours per week keeping up with the ever-changing medical literature within his specialty.  You will receive the latest evidence based care.

So is your choice option A or option B?  Of course the goal is to have the best of both and the two are not mutually exclusive.  However, the focus of current health care leadership seems to be on everything but helping doctors practice better medicine.  Do they not understand where the most important improvements in health care quality are to be made?  Do they really think that pretty offices and timely appointments define quality health care?  Is this what the general public believes or are they smarter?

Hopefully this extreme dichotomous example will help those in leadership focus on what it really important.

Adaptive Leadership and Health Care

Honestly.  Did no one really see this coming?  Did those in leadership positions just chose to ignore the signs?  Maybe they saw the warning signs and just didn’t know what to do.  The story might be comparable to the auto industry here in the US.  Ignored external pressures.  No willingness to change or adapt.   Anyway here we are.  Our health care system is now in full crisis mode.  The system doesn’t deliver care as well as it should.  The two most important stakeholders, patients and physicians, are very unhappy and fed up.  And now the external environment has changed dramatically with the Affordable Care Act.  In all likelihood the current health care crisis was preventable if there were thoughtful leaders in place.

Adaptive leadership is a strategy that dates back to a 1994 book titled “Leadership Without Easy Answers” written by a Harvard professor by the name of Ronald Heifetz.  Professor Heifetz has studied and written about leadership, adaptation, systems and change.  The publications describing his work are available at his website (  The foundation of adaptive leadership is change that enables the capacity to thrive.  The concept is analogous to the process of evolution.  A quote from Charles Darwin at the website states: “it is not the strongest who survive but those who are most adaptable”. Professor Heifetz notes that we are in an ever-changing environment that requires leaders to appropriately respond.  He states that one of the key issues that enables the capacity to thrive is the ability to distinguish technical problems from adaptive challenges.  Technical problems are those that can be solved with an organization’s current structure and processes.  Two + two equals four.  Technical problems can be fixed by an organizations existing authoritative expertise.  An adaptive challenge is significantly different.  As the title of his book suggests there are no easy answers.  The solutions to adaptive challenges involve “changing people’s priorities, beliefs, habits and loyalties”.  To HCR this sounds like a culture change.

Some of the key points of adaptive leadership outlined by Professor Heifetz may be uncomfortable for traditional leaders.  The first is that organizational adaptation occurs through experimentation.  Not too many leaders responsible for a bottom line are comfortable with experimentation but when you think about it every new initiative is an experiment.  Second, adaptive change takes time.  This is another way of saying that we need to plan for the long-term not just short-term profit and loss statements.  Other key points of adaptive leadership would seem to be less stressful for traditional leaders.  Adaptive leadership does not require a complete overhaul of an organization.  Leaders must identify and preserve what is working and identify and change what is not working.

Health care take notice.  The leadership of the health care system in the US has spent decades applying technical fixes to adaptive challenges.  Leadership did not see, or chose to ignore, the adaptive challenges that were in front of them.  It is now time for thoughtful leaders to make adaptive change that will allow the health care system to thrive.