| 11 December 2015
Dear Interested Readers,
Inside This Week’s Letter
As I mentioned last week, the letter this week will be a report of my impressions from the 27th IHI Forum that was held in Orlando this week. If you were there, I would love to hear your impressions. If you were not there or have never been to the IHI’s annual Forum, perhaps this report will stimulate you to go next year. At the least I hope it will give you an update on what is going on and what people from around the world of healthcare improvement are thinking.
The header picture this week was taken from the balcony of my room. It is a shot of the pool where I did not swim and the site of a huge party that I did not attend. I will admit to jogging on the walkways that you can see if you look closely at the palm-lined walkway around the pool area. The path by the pool leads to an excellent walking and jogging path that I took full advantage of each evening. It was not until my second evening that I noticed the signs along the path said to beware of the alligators and use the path at your own risk.
From early in the morning until late in the afternoon there was a lot happening in the convention center where over 5,000 healthcare professionals were inspired by an amazing number of workshops, courses, discussions and lectures they could attend. This letter presents an overview of the general sessions and then focuses on things that I learned from the four “keynote presentations”, the annual conference for CEOs and the two morning breakout sessions that I attended on the second day. Like nearby Disney World, there is always more to do everyday at IHI than one could ever do in a month. Choices are important. I focused my choices on leadership and the contradictory concepts of burnout and engagement. It may be a surprise that burnout and engagement are related. Burnout kills engagement and engagement is an antidote for burnout.
It is a long letter that was fun to write. It needed to be. There was a lot to report and it could easily have been twice as long. I hope that you will also find some time to visit strategyhealthcare.com. Show it to friends so that they can become readers of this weekly production that attempts to bring you interesting information and opinions to consider as you do very important work.
Overview and Themes of the 27th IHI Forum
Twenty seven annual IHI meetings is a remarkable number. All of the meetings that I have attended over the last several years have been in Orlando at the same large convention center and hotel complex. The attendance is usually between five and six thousand with about a third being physicians, a third being nurses and other clinicians and about a third being other healthcare professionals. Everyone in attendance is there to learn what they can contribute to the improvement of healthcare.
I have a sense that the program gets better and better with each passing year. I think that continuous improvement applies not only to quality, safety, cost and the pursuit of the triple aim but also to this meeting that examines these subjects. For me one of the most interesting aspects is to see how the conversation has evolved from year to year with our expanding knowledge and deeper insights as the conversation continues.
The theme for this year was “Recharge”. It could have been “review, refine, redefine, renew and rededicate”. It was also the last Forum under the leadership of Maureen Bisognano before she retires as CEO of IHI at the end of the year.
Over the years much of the work of the IHI has been done in big projects, in a series of large-scale efforts called “Breakthrough Series Collaboration”. The first attempt at “Breakthrough”, was a program to improve maternal and neonatal outcomes by reducing the rate of Caesarian sections. It was launched twenty years ago after Paul Batalden sketched on a napkin for Don Berwick and others his insight for this type of coordinated, multi-institutional attack as an effective approach to big initiatives.
The theme “Recharge” is closely aligned with another recurrent theme that I heard in almost every presentation, which was “return joy to practice”. Dr. Paul DeChant has been contending that the culture and process of Lean creates physician engagement and ameliorates the systemic issues that rob joy from practice. That was a settled issue at this Forum, as was the fact that Lean is an effective approach to the improvement of care. Lean or the “essence of Lean” was in every talk that I heard. The culture of Lean, with its respect for those who receive the care and do the work, waste elimination, the development of staff and the improvement of quality, was present everywhere. Sometimes the speakers called the subject Lean and on other occasions the culture and tools were discussed without a specific name other than the tools and mechanisms of quality or the “science of continuous improvement”.
The theme that I reported last year, namely asking patients, “What matters to you?” rather than just “What is bothering you?” continues and has been specifically enhanced. There is now an emphasis on using approaches that not only ask the question but also demonstrate interest. Patients get a message from our body language. The quality of the time spent with the patient demonstrates not only that we are interested in discovering what matters to them, but that we also want to understand their world as they see it. Good clinicians are aware of how comfortable patients are with them. They will seek to individualize care because they respect their patients’ values and desires as what matters most.
The triple aim has been restated as part of the work of a new program of collaboration called the IHI Leadership Alliance”.
Care better than we have ever seen, health better than we have ever known, cost we can all afford, …for every person, every time.
The understanding that the triple aim cannot be achieved if we just focus on the hospital and the office practice was reinforced time and time again. It is clear that the pursuit of the triple aim requires a coalition that includes many other members of the community and the engagement of patients. Leadership that is uniquely focused on inquiring, consulting, mentoring, teaching, engaging, communicating and involving others in determining strategy and direction was a focus because it is clear that large scale positive change will require new “standard work” for leadership. The issues of adaptive change and the balance between improvement and innovation popped up time and again. As I will discuss below, Don Berwick wrapped up the Forum with a magnificent presentation that called for a new era in healthcare. His challenge may be one that some are unwilling to accept.
Finally, there is a new challenge that is a specific updated articulation of the old principles of preventative care toward better health and what that could possibly mean for everyone, The 100 Million Healthier Lives Campaign. Consistent with a revamped and updated view of the challenges that face us and how best to engage in the improvement of healthcare and health was the presentation in several venues of a challenging set of “new rules” for radical redesign of healthcare.
New Rules for Radical Redesign in Health Care
Change the balance of power: Co-produce health and wellbeing in partnership with patients, families, and communities.
Standardize what makes sense: Standardize what is possible to reduce unnecessary variation and increase the time available for individualized care.
Customize to the individual: Contextualize care to an individual’s needs, values, and preferences, guided by an understanding of what matters to the person in addition to “What’s the matter?”
Promote wellbeing: Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require health care.
Create joy in work: Cultivate and mobilize the pride and joy of the health care workforce.
Make it easy: Continually reduce waste and all non-value-added requirements and activities for patients, families, and clinicians.
Move knowledge, not people: Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally.
Collaborate and cooperate: Recognize that the health care system is embedded in a network that extends beyond traditional walls. Eliminate silos and teardown self-protective institutional or professional boundaries that impede flow and responsiveness.
Assume abundance: Use all the assets that can help to optimize the social, economic, and physical environment, especially those brought by patients, families, and communities.
Return the money: Return the money from health care savings to other public and private purposes.
Now for the part I love the most, creating for you a sense of the “aha” moments that I enjoyed. Please forgive me when I repeat some of the things from the overview.
A Job Well Done
Maureen Bisognano presented the first keynote as one of her last appearances as CEO before retiring at the end of the year. She has been at IHI since 1995 having been the EVP and COO from 1995 until 2010 when she became CEO after Don Berwick left the position to become the Administrator of CMS. During her five years as CEO she has effectively lead IHI at home and abroad in its worldwide mission.
Her presentation was entitled “Gratitude”. She pointed out that gratitude is a form of social capital and then connected it to a series of “How We’s”
- How We Improve: with programs like 100 Million Healthier Lives and the New Rules for Radical Redesign in Health Care.
- How We Hear: The Voice of the Patient. We should decrease the work and burden of illness by making care simpler. We should ask not only “What’s the matter?” but also “What matters to you?”
- How We Teach…and Learn…and See. She suggests moving from being the “sage on the stage” to the “guide on the side”. Medical students should be exposed to care in the community.
- How We Care: prescribe walks in the park and bike rides, not Ritalin. Use smartphones to deliver advice when patients need it.
- How We Lead; Cultivate curiosity. Move from “Fix and forget” to “See, solve and share”. Find leaders who not only have a high IQ but also a high EQ and high CQ (curiosity quotient). Our leaders should not only lead innovation but they should advocate for “exnovation” and “undiffusion”
It was a terrific talk and afterward she received the well-deserved praise from many for her twenty-year commitment to IHI. Her son then read a letter of congratulations and an acknowledgement of her contributions from President Obama.
A Lean/Innovation Day with CEOs
After the early keynote address from Maureen Bisognano, the middle of day one was filled with the CEO meeting. Unlike the experience of past years, it was a continuous discussion of Lean and Lean driven innovation. Gary Kaplan, the CEO of Virginia Mason, introduced the day’s agenda and gave a superb overview of the status of Lean and Lean driven innovation at Virginia Mason. Derek Feeley who will be the CEO of IHI after January 1, expanded on many of the ideas Maureen had presented in the keynote address with a talk titled “Aspirations and Opportunities”.
Derek then introduced Chris Trimble, a professor at Dartmouth’s Tuck Business School and the Dartmouth Institute. He is a fabulous speaker and is the author of How Physicians Can Fix Healthcare: One Innovation at a Time. His presentation was a Lean talk and he never used the word Lean. He just described its principles and culture as the core of the methodology by which physicians can fix healthcare.
After Professor Trimble, Dr. Jeff Thompson, CEO of Gundersen Health, continued the review of innovation and described in detail how Gunderson used Lean to remove waste and improve resource utilization while lowering the cost of care and improving quality. Finally there was more Lean celebration and testimony via a terrific review of Lean and innovation by Helen Macfie, the Chief Transformation Officer at Memorial Care in Southern California.
I was impressed that the world seems to be changing. Despite the apprehension that many express about physician acceptance of Lean, these high performance organizations reported enthusiastic physician engagement and spectacular results from Lean based operating systems and in Lean driven organizational cultures. It was clear from their presentations that they were from organizations that had effectively managed the transition from volume to value using the principles of Lean and the emergence of a Lean culture to act locally to improve the lives of the patients in their communities.
I had never heard of “exnovation” and “undiffusion” until Maureen’s keynote. But those words came up several times in the CEO conference. Perhaps they are new words for you also. Click on the links to learn a little more. When we realize the complicated nature of healthcare it is a relief to know that there is a growing experience with how to stop doing things that do not contribute to the desired outcome. Overproduction and over processing are rampant forms of waste that are easy to see in every healthcare organization.
Magic in the Magic Kingdom
Magic Johnson is one huge man. More impressive than his size 15 feet or his massive shoulders is the breadth and the warmth of his smile. I will admit that I was drawn more to see what remains of this NBA Hall of Famer than to hear his message. I was not sure what he would have to say that would add to my understanding of the issues that face healthcare. I was vaguely aware of his HIV/AIDS activism. I knew that after his NBA days he had become a very successful businessman who owned a wide spectrum of businesses in distressed neighborhoods across the country, and had turned some of his vast wealth into a foundation, but isn’t that what all super-rich former athletes do?
From the moment I saw his yard wide smile and heard the enthusiasm in his voice as he eloquently described his commitment to improving the poorest communities in urban and rural America, I was sure that I had much to learn, so I dropped my skepticism and just enjoyed listening to him. He did not talk at all about his famous college and NBA career. He defined his purpose as the community work and the HIV/AIDS work that filled his day after arising each morning at 4:15 to meditate, stretch and work out for two hours before beginning his day.
His description of how he learned he had HIV infection and what he did to put his life back together was a stunning example of an emotional journey from disaster to triumph. His first response was to go to his wife. He learned on the advice of a physician that cared enough to challenge him that he must work to “get his smile back”. He followed instructions and took a difficult regimen of fifteen meds three times a day that is now, through science, reduced to three pills a day. He considered himself blessed, recognizing that his wealth and fame gave him access to care that everyone deserved and he is resolved to do what he can to make sure that even the poorest members of the community get it. He is brimming with gratitude and joy that he is alive and well living with a chronic health problem. He proudly boasts that he is in good health 24 years after his diagnosis.
Perhaps most impressive is that he is an enormously successful businessman who has used his businesses to improve the jobs, education and housing opportunities of minorities in the city. He understands the origins of healthcare disparities and he is constantly devoting his strategic competence to doing what he can to correct those realities.
If his presentation was eloquent and clean of any attempt to inflate who he was, his ability to conduct a Q & A that treated every question with deep thought and produced amazing answers while elevating the questioner to his height, was even more amazing. The man has the complete package of IQ, EQ and CQ. His skill is the result of hundreds if not thousands of meetings with community groups, schools, colleges and churches as well as medical institutions and business groups as he pursues his mission. He lovingly turned the tables on those who asked questions. Through the questions that he asked of those who asked him questions, he revealed a mastery of the art of engagement. He could teach clinicians a lot about finding out “What matters to you?”.
If the conference had ended with Magic, it would have been a great experience, but there was another day ahead.
The Digital Doctor and the Social Entrepreneur an Interesting Tag Team Keynote
Robert Wachter is the Professor and Interim Chairman of the Department of Medicine at UCSF. He is also the author of a compelling book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. He began by pointing out that because of the 30 billion dollars spent by the government the use of computers in medicine had skyrocketed from 10% of offices and hospitals in 2010 to 75% in 2014. Those of us who have been using computers in healthcare since the late 60s have been joined by a stampede of new users. He postulates that every industry that has become computerized has needed to change the way it works. The old analog workflows do not work well with the new technology. The new technology also creates opportunities for further stress by encouraging disruptors. Think about ATMs, bank tellers, Uber and cab drivers and the old motel versus AirBNB. He predicts that the pressure to deliver high value care will overlap with the stress of the digitalization of the US healthcare system that will evolve over the next ten years.
He points to the transformation in radiology as the canary in the mine. When digitalization of film emerged the x-ray teaching rounds ceased and radiologists making $400K in America were in competition with radiologists making 40K in India. ICUs have had digital technology longer than hospitalist have had digital records. Both now have “alert fatigue”. Residents are no longer writing in charts at the nursing station where other interactions that benefited the patient once occurred because they are now pouring over computers in isolated workrooms. The patient in the bed has been replaced by the iPatient on the screen and we are not quite sure what that means.
Wachter presented the emergence of digital medicine not as “technical” change where the user just had to learn a few new operating principles as the operator quickly mastered the new tool and became more productive, but rather as change that requires the user to change or adapt:
“…problems that require people themselves to change. In adaptive problems, the people are the problem and the people are the solution. And leadership then is about mobilizing and engaging the people with the problem rather than trying to anesthetize them so that you can just go off and solve it on your own.”
Ronald Heifetz, MD, Kennedy School of Government
He spoke of the “productivity paradox” of Erik Brynjolfsson of the Sloan School. New technology leads to a fall in productivity until the work is reimagined. He concluded with the expectation that new work flows would emerge, but that there would be new and surprising scenarios as we attempt to blend medicine with the new technology. As an example he told a story about interactions with a family at the passing of a parent where the decision to move to “comfort only” was in conflict with leaving the patient on a monitor. When the family came into the room to sit with their departing loved one they were unable to focus on the moment until the monitor was disconnected. Computers will never relieve us of the responsibility to be aware of where our patients are and what our responsibility is to them and their families.
Dr. Wachter’s keynote was followed by an upbeat new strategy for improving healthcare and everything else in our tired and jaded world…look to children for the answer. I guess this is an extreme form of crowdsourcing and totally appropriate since politicians, economists, and climate scientists keep telling us about the mess that our children are going to inherit. They need to get to work now!
Craig Kielburger was twelve when he was moved by a story in the newspaper about the assassination of a twelve-year-old Pakistani activist against child labor and decided to start a movement called “Free the Children”. The movement is now a worldwide organization renamed “Me to We” involving over two million children in projects of social action and community service.
“Me to We” has built 650 schools that educate 55,000 children every day in developing countries. It has medical clinics around the world. Mr. Kielburger is a “secular” missionary who has probably not had his 40th birthday, but is the recipient of numerous international awards for humanitarian accomplishments as well as 15 honorary doctorates from universities around the world.
“Me to We” fills stadiums and arenas like a rock band with tens of thousand of joyous “kids” eager to be active. They collect tons of food for food pantries and do numerous other projects to improve health and life through community action at home and abroad. Kielburger has objective data to show how activism improves the health and academic performance of the participants. Kids are pretty amazing when they are convinced that they can change their world.
Leading Up to Don With Sessions on Leadership and Burnout
The IHI has spent an impressive amount of effort observing, describing and developing leadership. I chose to spend the “elective” part of my day catching up on their latest thinking. On their website you can find a white paper on these new leadership concepts but I will try to give you some highlights here. One of the authors of the paper, Michael Pugh, MPH, a consultant, was the first speaker and he was followed by David Munch, MD of Healthcare Performance Partners, a Lean consultancy.
Mr. Pugh began with a couple of questions. Can you communicate what is really important in the time it takes you to walk about 20 feet with a colleague or employee? Can you frame your explanation from the patient’s perspective? He reminded us of Paul Batalden’s famous observation:
“Every system is perfectly designed to produce the results it gets.”
Then he reminded us that as leaders and clinicians we were responsible for the results of those systems.
He described the connection between the triple aim and IHI’s “High Impact” Leadership Framework. The leadership framework emphasizes culture, collaboration across silos, and across organizations and community, the development of capabilities, the creation of vision and the infusion of will. It is a tall order. He listed the components as:
- Person-centeredness
- Front Line Engagement
- Relentless Focus
- Transparency
- Boundarilessness ( a new word?)
He emphasized that “how leaders think” is important since their beliefs, theories and assumptions define the universe of potential solutions and actions. [You can review the candidates for president with this thought in mind.]
Here is the image that depicts the new IHI model of the “High Intensity” Leadership Concept.
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| | The presentation then moved to the critical and changing role of “middle managers” and the need for them to shift their thinking. For example, rather than think that being “nice” drives patient satisfaction, they must recognize that patient satisfaction is driven by engagement of patients and families in care delivery. Another mind shift is to realize that improvement projects are not best done in addition to daily work but that improvement is part of the daily work of everyone. Finally rather than manage to a budget they should realize that real progress is made in lowering the cost of care when they seek to continuously reduce operating costs.
As an overview Mr. Pugh said that there is always a business case for improving quality and service but whether or not there is a financial case for a specific improvement strategy is a different issue. He pointed out that 25-50% of all healthcare costs are directly attributable to processes that produce waste, rework, needless complexity, incorrect clinical decisions, adverse patient events and excess clinical intensity. Many of those wasteful processes were initiated to improve quality and service. Clinical processes need to be redesigned to eliminate waste, as defined by unintended variation, rework, error, valueless care, and needless complexity. The measures should be clinical outcomes, finance, and patient experience.
The talk progressed to defining or suggesting standard work for senior management, middle management and the “frontline”. Senior managers support and enable middle managers who then in turn enable the frontline. The frontline serves the patient. He posited that, “The biggest barrier to manager engagement in quality is “overburden”, doing the often-unnecessary work of getting through the day.
The talk was loaded with insights that I have just begun to pass on to you. My advice is for you to look for the paper IHI white paper on High Intensity Leadership. You can click on this link to download the paper and listen to a short video from Mr. Pugh.
My mind was in a swirl by the end of the discussion. What I had just heard was a detailed and enhanced expansion of the definition of the Lean leader, which is to lead by being a coach, mentor, and teacher who is engaged across and beyond the organization and demonstrates a relentless passion for measurable improvement through the support of those who do the work.
The next presentation was like a second helping from the same dish. The speakers began with the same slide depicted above. There objective was:- Identify three factors that decrease burnout and raise engagement
- Describe the actions of leaders that engage physicians in quality and safety
- Plan next steps for their organizations in reducing burnout and raising performance
Much of what they reported came from ongoing studies within IHI and at the Mayo Clinic. Their theory is based on creating engagement, the opposite of burnout, by maximizing the satisfaction of “innate human needs” that included camaraderie, choice, excellence and equity. They postulated that to eradicate burnout they must:- Deliver on the psychological or as listed above, the innate human needs,
- Mitigate the systems deficiencies that were drivers of burnout, like improve workflows with Lean
- Do something to bolster the resiliency of those currently affected by burnout.
They also added that effective inspirational leadership was beneficial in the reduction of burnout. Their research showed that the five drivers of burnout were:- A lack of flexibility and control
- Poor work efficiency
- Poor work-life integration
- An inappropriate workload
- A loss of meaning and purpose
The IHI Leadership Alliance has created a “Joy in Work” subgroup. Click on the link to learn more.
And Then Don Spoke
Don Berwick was the last keynote speaker. His “message” closed the 27th IHI Annual Forum as it has done many times in the past. I would have flown to Orlando and waited two days doing nothing just to experience the joy of being present among the 5,000 plus attendees to hear what he has been thinking about over the last year. What amazes me is that he has been thinking about the same things continuously for over a quarter of a century and the insights just keep getting more and more profound.
It is as if he has been climbing a mountain, and the higher he gets the better the view and the clearer the air. He did use a mountain metaphor as the core of his presentation. He has climbed Mount McGregor in Washington twice in his life. The first time he had a guide who knew the trails. The second time he took a friend and thought that he could find his way. There are many confusing trails near the summit and all but one end in a dead-end and you must come down or back track to find the right trail to get to the summit. Don and his friend followed many false trails trying to get the summit. Each time they realized they were on the wrong trail they were willing to go back and start again on another trail. After many wrong turns they eventually found their way to the top.
Don postulates that healthcare in general, and physicians in particular, have been on some dead-end trails. He described two eras in practice. Each era was positive for a while but eventually the trail came to an impasse. Giants like Hippocrates and Galen characterized Era 1. In Era 1 physicians had noble intent and specialized knowledge that no one else had. They were beneficent. Like all professions they were self regulating, a rule unto themselves. He quoted Eliot Freidson,
“A profession is a work group that reserves the right to judge its own quality”.
Freidson turns harsh,
“While the [medical] profession’s autonomy seems to have facilitated the improvement of scientific knowledge about disease and its treatment, it seems to have impeded the improvement of the social modes of applying that knowledge.”
Despite the fact that in Era 1 we failed to learn how to effectively apply our knowledge to everyone’s benefit, it had the positive characteristic of trust. Patients and the community trusted their doctors. Doctors had a prerogative that allowed them great clinical autonomy. They were focused on science with inquiry and research and they practiced great mentorship to those coming up in the profession.
Don thinks that Era 1 ended thirty or forty years ago and Era 2 has had harsh accountability, increasing scrutiny, and excessive measurement of many things that do not add value. There has been an intense attempt at a carrot and stick approach to motivation with the duality of accountability and scrutiny confused by complex incentive schemes. All of this has induced doubt in the minds of physicians and apprehension in the consciousness of their patients, other healthcare professionals and the public in general.
Don anticipates a new “third era” where we come back down the trail from our most recent dead-end and then make a new attempt on the summit. The summit is a good metaphor for the triple aim which he articulates in its new form as I introduced before as:
Care better than we’ve seen, health better than we’ve ever known, cost we can afford…for every person, every time.
As we come back down the trail we will need to:- Stop excessive measurement
- Abandon complex incentives
- Decrease the focus on finance
- Avoid professional prerogative at the expense of the whole
Going up the new trail as we start again we will need to take the following positive steps:- Recommit to improvement science
- Embrace transparency
- Protect civility [He spent some time talking about how we treat one another as well as our patients. Our society seems to be moving to a deficit in civility. Think again about the political campaign.]
- Listen. Really listen
- Reject Greed
Yes, he did talk about our greed. He presented a case that was taken from a friend’s experience that was rife with overpriced and unnecessary tests compounded by up coding. He made slides of the chart from the EW of a suburban affiliate of a well known AMC where the care occurred. Since he was there with his friend, he knows what was done and what was not done. That story was presented in stark contrast to a complicated patient managed by a team at the old HCHP when Don was in practice. The comparison was powerful. The case of the HCHP patient was a good example of how care might be provided to create real value in the emerging third era.
Don pointed out that there are things that we should retain from Era 1- Professional pride
- Commitment to science
- Beneficence
From Era 2 he would hate to lose- Transparency
- Sensible payment mechanisms
- Patient engagement
At times when Don told his clinical stories I was either in tears of empathy with Don and the patient or bristling with anger at the system. When he finished the speech, I agreed with him that to implement his ideas would require a “movement”. I did some numbers in my head. If there were five or six thousand healthcare professionals in the audience, maybe a thousand were from abroad. Of those present who were in American healthcare, there were roughly about 1500 doctors, 1500 nurses, and 1500 other healthcare professionals. My guess is based on observing nametags and on the fact that I have a list of attendees. There are about a million doctors in this country and more nurses than doctors plus millions of others professionals in positions of leadership in healthcare. Even though the audience arguably contained some of the most committed clinicians and lay leaders we have who support the dream of the triple aim, it is most likely that only a few tenths of one percent of the healthcare professionals in the country were present. The other 99.95 % plus who must sign on for the climb to the summit were not present for the marching orders.
Don was preaching to a very small choir. It must therefore fall to those who heard him and agree with his spirit, direction and analysis to do a lot of work spreading the ideas that he has so profoundly articulated. Just as our environment remains vulnerable to the shrugging of our shoulders when the subject of climate control comes up, I believe there is a deeply ingrained sense of futility that is part of a larger loss of professionalism in healthcare. So as Don suggests, it is easy to take the money and keep on going to work every day with your head down as long as the gig lasts.
I am gullible when it comes to numerators and denominators. In 1972 I was wildly enthusiastic about the candidacy of George McGovern. All my friends and even people I met on the street in Boston seemed enthusiastic about him. He seemed a sure bet for the White House. We all knew that Nixon and his henchmen were crooks. As you remember, George did carry Massachusetts in a landslide. It was the only state he carried. It feels the same to me now when I talk with people about the exciting possibilities in the future for healthcare. All my friends at IHI and GPIN and the places I go agree, but then I remember George and I am not so sure about the future and I realize that there isn’t very much any of us can do alone.
It will take a movement and every one of those people who heard Don needs to recruit and educate several hundred other people. You can occasionally see a few stars twinkling on a dark and mostly cloudy night and Don did give us some examples of practices and hospitals that get it and are making a difference as they twinkle to our amazement but there aren’t many of them yet in our dark sky. There is a lot of work to do. Maybe we should recruit the children from “Me to We” or get Magic Johnson to be on permanent tour preaching his message of taking care of everyone.
Walking Around The Country
What really impressed me about Magic was his ability to commit. He does everything full tilt boogey, including his focus on being healthier. His story reminded me of a quote I have used before from Oliver Wendell Holmes, Sr. MD, father of the nonagenarian Supreme Court Justice, Oliver Wendell Holmes, Jr.
Old Dr. Holmes was a nineteenth century renaissance PCP to Boston’s Brahmins, and one himself. He lived to be active in his very late 80s. When he was asked what the secret was for a full life and longevity he said, “Get a chronic disease and take very good care of it.” I saw that paradox in action many, many times in practice and would frequently quote Dr. Holmes’ line to one of my patients who might be struggling with their own chronic medical problem.
Magic eats right. He gets plenty of sleep. He takes the meds that are prescribed. He meditates and stretches and then he exercises a lot. He follows the same schedule of self-care every day before he does the things that bring purpose and meaning to his life. He should be the poster person for the 100 Million Healthier Lives project. You probably will never be able to beat him in a pickup basketball game but all of us can endeavor to match his health habits. He has learned to make good choices and he is spreading the word.
I have had an unusual week. I am trying to be like Magic and exercise even more than usual. I am trying to improve my stretching. I have always avoided meditating and stretching. By the time you read this I will have walked or jogged at least five miles in New Hampshire, North Carolina, Florida and California this week! I am walking in the redwoods above Santa Cruz this weekend. The weather everywhere seems quite good for a walk, which is a little scary given that we are into the second week of December. Perhaps it is the upside of global warming. I will take the warmth for now and hope it enables you to follow Magic’s example. |
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