When former Vice Presidential candidate Sarah Palin infamously predicted that the Affordable Care Act would create “death panels”, I wanted to wring her neck. She took an incredibly important, albeit difficult, issue and trivialized it for the purpose of promoting her election/brand. With this hyperbole, I reasoned, we would not be able to have the serious national discussion about wasteful spending on end of life care.
And we haven’t.
Little did I know that there would be another issue — one which has not yet hit Ms. Palin’s sound bite radar that could potentially be more problematic, and politically explosive, concerning our efforts to control healthcare costs: the use of big data to influence lifestyle behaviors in a quest for effective population health management.
Merchant marketers are already doing it. A woman who has just found out she is pregnant, visited a Target store. Flush with the news, she made several purchases that would suggest she was pregnant. She told no one except her husband. Yet, two weeks later, she received a direct mail product promotion hyping all the things that a new mother will need. How did they know? Simply by looking at her purchases using marketing algorithms specifically designed for this purpose. Voila, a slick direct mail brochure customized for her medical condition that was supposedly a secret.
In what I believe will become a major professional/moral clash between the financial imperative to modify unhealthy lifestyles in order to lower our astronomical healthcare costs and the patient’s right to privacy, healthcare systems are beginning to mimic the retail industry.
Bloomberg’s BusinessWeek magazine recently revealed that large health systems are acquiring consumer data streams so that they can be, theoretically, proactive in managing their patients’ health, a financial imperative in the healthcare system of the not-to-distant future.
The illustration they selected to prove their point: a Marcus Welbyesque physician looking at a female patient with the caption: DON’T LIE TO ME SUSAN, I KNOW ABOUT THE 2 A.M. PAPA JOHN’S DELIVERIES.
“Imagine getting a call from your doctor if you let your gym membership lapse, or make a habit of buying candy bars at the checkout counter, or begin shopping at plus-size clothing stores.” For patients who use the Carolinas Healthcare System, that day could be sooner than they realize, the article predicted. They have begun plugging in the consumer data of 2 million people into algorithms designed to identify high-risk patients so that doctors can intervene before they get sick.
The hospital is developing risk scores for patients, and within two years the health system plans to routinely distribute those scores to doctors and nurses who can then reach out to the patients suggesting changes before they become ill.
Dr. Michael Dulin, Chief Clinical Officer for Analytics and Outcomes, posited that many retail companies are already using data to encourage people to buy things that may not be in their best interest. “We are looking to apply this for something good,” he told BusinessWeek.
That may be, but I can already hear the talking heads decrying this inappropriate intrusion by Big Brother.
I do not believe this characterization of an important population health management strategy is fair, but in this current political environment, if you want fair, come to Dallas in October. They call it the state fair.
© 2014 John Gregory Self
Healthcare leadership, really good leadership, is more than achieving objectives, hitting the numbers, making the bottom line.
During periods of transformational change, leaders have to offer more – exceptional dedication, and, most of all, inspiration.
It is always surprising to me how many people in healthcare dislike, intensely dislike, change even though our industry has experienced 20+ years of fairly dynamic change, primarily in technology. This alone, this glaring fact of human nature, requires leaders who understand this and who will work diligently to bring along their conflicted colleagues with their vision.
In Wednesday’s post, I borrowed the Rev. Barbara Brown’s light bulb metaphor from Matthew’s version of Jesus of Nazareth’s Sermon on the Mount. We all have a light bulb. It is a gift from the Creator. What we do with this gift, the Rev. Ms. Brown said, is the real issue in life. Leaders have a special duty when it comes to their light bulb. The difference between great leaders, the decided minority, and the so-so crowd is the wattage we pump into the bulb. How brightly do we illuminate the room – our organization – for the people who follow us?
So we return to the wattage issue – what we do with the gifts and talents we have. I believe the wattage is comprised of dedication, passion and the desire to inspire. In earlier posts, I have used the example of the traveling evangelist leadership model, the CEO who proudly and frequently – with every interaction, in every meeting – talks about his or her vision for excellence in quality of care and the safe treatment of patients. This type of leader energizes the workforce – from physicians to the hourly workers who clean the rooms – to singularly focus on making what we do a very personal mission as if we were treating those we love the most.
Happy are those who benefit from this leadership light, this moral imperative.
© 2014 John Gregory Self
Most healthcare leaders have graduate degrees. Their rigorous coursework and years of study prepared them for a journey that, theoretically, helped them to become good leaders in an industry where the quality of leadership can mean the difference between patient safety and harm, life or death.
The other night, on a long flight home, I sat across from a well-known hospital CEO. As we waited to board, he told me he was working on a speech about leadership. After the cabin service was complete, and the lights dimmed, he took out his work, including a book. It was not some tome on the latest crazy fad on leadership, but the Bible. At first I thought he had changed his mind about working on the speech. “There are some great leadership themes in this book,” he explained when he saw me glance over. At first I was a little surprised but as the flight wore on, I thought about my own recent readings as well as a sermon that I had listened to a few weeks earlier. The Rev. Barbara Brown Taylor, an Episcopal priest who has been ranked as one of the best homilists in the Christian faith, spoke at the Duke Chapel on the grace of good works. Her sermon helped me reframe and refocus my thinking on leadership and the responsibilities leaders have to those they serve.
Drawing on Matthew’s Gospel account of the Sermon on the Mount, the Rev. Ms. Taylor highlighted Jesus’ words: “You are the light of the world.”
These are such powerful words in any context, as both inspiring and as a call for serious introspection. For me, they provided an easy shift to an important theme in life and in business: CEOs are the light for their organizations. When leaders ascend to the top position, they bring with them their gifts. When they are appointed, they are given, in effect, a metaphorical light bulb, or as the Rev. Taylor called it, the “t-shirt before they even run the race.” What they do with that gift — the wattage they expend to illuminate the room — is really up to them, she said.
Sadly, some CEOs don’t really get it, that leadership is not all about their authority of command and control. To be honest, this approach takes very little wattage and the operating results are usually fairly dismal, from mediocre quality of care and patient safety to an anemic bottom line. The light from these CEOs can barely illuminate a broom closet. I would also be willing to bet that these leaders are not really fulfilled with their jobs.
Then there are CEOs who understand that their role is not about their authority and power over others but the example they set for their organization, the wattage they invest in powering that leadership light bulb for others. They go all out and the light they produce shows to everyone not only the way forward but who they are, not just as a leader, but as a person. That level of transparency is so important in these times of uncertainty and transformation.
Being talented, knowing how to run a hospital, how to be a good steward, is not going to be enough in the future, my seatmate said. “I am leading a big complex organization over which I cannot exert much control day in and day out. I have to focus my energy on leading in a way that will inspire people to follow, to care passionately about our values, what we are doing and how we do it – quality and safe care every day, with every patient. No exceptions. Policies and procedures will not guarantee that.”
He is right. It takes so much more, something in addition to the title and all the trappings of being the boss — the corner office, all the perks and financial incentives. There are many CEOs who are paid extremely well, work in beautiful offices with the support of legions of executive assistants, who fail miserably.
The leaders who expend the energy to maximize the wattage in their light bulb — their leadership gift – will create an environment that is so much better for everyone around them. To paraphrase from Matthew’s Gospel, happy are those who live and work near you. Happy are those who share the world with you.
That is what the guy across the aisle believes.
© 2014 John Gregory Self