Work and the Future is the place to consider how to make daily and systemic improvement in health and healthcare….and more, to consider how the workplace itself is central to the creation of an entirely new social dialogue that we must create in order to attain that which we aspire to:  a high quality of life…….. for all.

We live every moment in  a crisis of poor health, which sadly and unjustly is highly discriminatory based on race, ethnicity, and income, where health and health outcomes are worse among our neighbors of color and our neighbors who have a difficult time affording healthcare. It is one of the great tragedies and failures of our  society, the wealthiest in history that we do not have a health care system which is affordable or effective for individuals or for our nation.

The SARS-CoV-2 virus which has caused the COVID-19 pandemic has further broken our non-system of healthcare.  The early days of the pandemic placed all healthcare workers in a position that they never want to find themselves in:  not knowing how to help people as they flooded emergency rooms with a novel disease for which there was no known treatment.  Death, overwhelmed units, and staff shortages broke many people who work in healthcare.  Trauma ensued, and many chose to no longer continue their professions.

The pandemic has gone on for more than two years.  Much has been learned about treatment and how to manage the trauma of staff.  Sadly, all of the failures of the system that existed before the pandemic remain, and a climb to normalcy seems incomprehensible.

That is because, as we are seeing in the workforce generally, normal was not good before the pandemic.

Healthcare reform will be front and center again soon.

Our communities need healthcare and more importantly, they need to have conditions which support health…these dual challenges remain.  Time for reform, as has been the case for far too long will never be soon enough.

Everyone in healthcare has an obligation to find the means to improve.

Time is short…but we must not allow the crisis to blind us to the necessity of a new way of thinking which is required to transform a healthcare system that has been in place for more than a hundred years, a system which has produced poor health and financial disaster.  Let us not rush.  Let us get it right for the long haul.

It continues to be the case that healthcare makes up nearly 20% of the Gross Domestic Product of our society. 30 years ago, it was much less, closer to 12%. Growth and cost of healthcare far outpaces the value we get.

CMS reports that the United States spent $4.1 trillion on healthcare in 2020.  This expenditure makes of 19.7% of GDP, yet this enormous spending does not produce a healthy population.  We know that $4.1 trillion spent is largely wasted on errors, omissions, missed preventative opportunities, duplicate services, high prices, high administrative costs, fraud and  abuse.

Even though health insurance has been extended to segments of the population heretofore excluded, far too many in our society still  cannot afford healthcare as part of their family budget. Even more of our people, the so-called “undocumented”, and those in states where politicians disallow the federal expansion of Medicaid are without insurance, even with reform. Like most system failures, the waste and inequity are the result of a lack of design of the systems that produce ill-health and wasteful use of our precious resources, both human and financial.

Many healthcare improvement efforts are underway ranging  from  large-scale whole systems  improvement to small-scale individual projects.   Hierarchy, bureaucracy, rapidly changing payment models, new delivery system organization and new and dramatic demands on a highly disaggregated system all  contribute to slow and uneven improvement.  Our  unhealthy  population, poverty, and a lack of easy access to primary, preventative care are major drivers of the barriers to improvement.

Another major factor in the slow pace of improvement is low employee engagement.  We know that the huge investments and high expectations for improvement  cannot succeed  without high employee engagement. It is the reality that workplaces are microcosms of  our communities, places of hope, places of disappointment, often places of anxiety and even fear.  As the healthcare workplace continues to be pummeled by the  rapid implementation of new technology and communication capability, new care models, new financial pressures, new demands for flexibility and rapid change, high expectations from patients as well as the demand for improved outcomes and lower costs, our workforce’s effectiveness is being crushed under extreme pressure.  We  also know what the antidote  to the pressure and anxiety are:  that employees feel valued…that they are part of creating the engagement systems that energize their participation.

WORK is not valued as the human condition that it  actually is.   Work is so much a part of human experience that  it can be, as many have suggested the human activity most likely to engender continuous learning and engagement not just about work, but about the relationship of work to virtually all social structures that make up society.

We must keep in mind that the most important things to value in people are their wisdom and their experience. How that wisdom and experience are unleashed will determine engagement and effectiveness… through a new way of thinking.

Let’s learn together…

I have experienced and participated in large-scale improvement strategy in healthcare…with the 9 million (at that time) patients and members of Kaiser Permanente; with Allegheny Health Network in western Pennsylvania, the second largest system in the region,  with New York City Health and Hospitals, the nation’s largest public health system, with the Delivery System Reform Incentive Program for the New York State Medicaid Reform,  the $8 billion program designed to improve the health of New York State’s largest in the nation Medicaid population, and for many years with local unions and the International union of Service Employees International Union, the nation’s largest health care Union.

As a co-lead of the labor-management partnership at Kaiser Permanente for eight years, I was a leader of the successful engagement of 100,000 employees, 15,000 managers, and 17,000 physicians which was central to the success of Kaiser Permanente’s rapid improvement in clinical outcomes, patient experience, and affordability.  Through that experience I learned that continuous improvement is a function of continuous organizational engagement of the frontline staff in strategy, strategic problem-solving, business literacy, transparency and use of relevant data.

Most important, and central to the purpose and themes of this website is that QUALITY is not simply a goal…QUALITY is a way of thinking, a design for work and work processes, and it is the the BEST measure of outcomes. QUALITY is the strategy to create VALUE.

I have seen employee engagement scores skyrocket in direct relation to employee involvement in structured and strategic quality improvement initiatives.

Work and the Future is a place to share experiences with others, learn, build, experiment, but most importantly create, document, and spread ripples in the ocean so that they become the  huge waves of improvement in the quality, safety, experience, and cost of health care delivery in our society.

We must create hope and vision that we can succeed. The good news is that we also are in the midst of a dynamic period of new and emerging efforts to achieve significantly improved health while  making access to healthcare truly affordable. In so doing we can free up so much of the wasted resources that go to our failed healthcare sector and use those resources for other social needs.

I believe that the improvement of health and healthcare is the largest single social justice movement in our society.

And, the task can seem overwhelming, not unlike the challenge of saving the planet from human-made warming and pollution.  But we have no choice, and the millions of people who go to work in our healthcare workplaces can contribute to the solution, patient-by-patient, day-by-day. This is the ONLY way we can succeed.

And as we do, the awareness that is raised, the collaborative effort required, the civility that is inherent, and the focus on the patient, creates new thinking, new consciousness.

The awareness that is raised in the healthcare sector can be a beacon of learning in all sectors of our society.  QUALITY as a strategy must replace GROWTH as we  outlive the Industrial Revolution.  We can learn to measure Quality of Life as we learn better to measure Quality and Value of healthcare.  Many oxen will be gored in the process…but history is leading us to a fork in the road we must take:  volume and inequity or quality and value for all.

In healthcare this discussion is underway.

Thank you for visiting this site.  I hope you will both explore and exchange ideas.

John