Where are the adaptive leaders in healthcare?

(Originally published by wpahospitalnews.com … Issue No. 5)

A leader at a local community hospital recently shared a “success” story that concluded with a technical solution. The challenge at hand included the increased number of ER visits, the lack of efficient access to the floors, and the numbers of patients waiting excessive lengths of time for care. The technical solution was a significant capital investment and building of an expanded emergency department at this hospital.

And yet, at no time did anyone truly explore a more adaptive solution by investigating the reasons for the increase in ER visits. No one engaged people both inside and outside of the hospital in the tougher discussions to better understand the root cause of this increase.
While the technical solution addressed the symptoms of the problem, a more adaptive solution could have truly addressed the underlying cause of the issue, perhaps even at a lower cost. An adaptive approach might actually solve the issue (and improve the health of both individuals and communities and decrease the reliance on the ER).

Recently the medical staff at another local hospital met and discussed a challenge they were facing. They had learned that their technical fix to lower blood sugar levels in people who have been admitted to the hospital with blood sugars over 300 was not yielding desired results (80 to 90 percent of patients still had levels in excess of 300). After much discussion the proposed solution was to change the goal (raise the blood sugar limit to 350).

In essence, the medical leaders at this institution implemented an unsuccessful technical fix and then resolved to change the goal rather than participating in the more challenging, demanding and risky discussions focused on collaborative and adaptive change. An adaptive solution could challenge multiple constituencies, yet would get to the root cause of the inflated blood sugar levels and again improve the health of both individuals and communities.

A local physician also recently shared this with a colleague of mine: “An obese woman came in to see me. Even though I have limited time with each of my patients I was successful in referring this obese woman for bariatric surgery.” I am not a clinician and do not know if in fact the best option for this particular patient in this specific case was bariatric surgery. But I do find it interesting that the physician’s decision was a technical solution positioned as the “best I could do” based on limited time with the patient. And that at no point did this lead to a larger discussion focused on finding an adaptive solution to the limited time issue, nor on making an adaptive change by engaging this and other patients in determining the root cause of specific health challenges.

In Ronald A. Heifetz and Marty Linsky’s book Leadership on the Line: Staying Alive through the Dangers of Leading (2002), they share the following:

“Every patient looks to the doctor, hoping for a painless remedy; and every day doctors have to tell people that their health depends on enduring the pain of change – giving up their favorite foods, taking time out of each overextended day for exercise…”

“They (few doctors) had learned how to engage patients and their families in reshaping their values, attitudes, and long-standing habits.”

“… many more doctors give little more than lip service to this part of their job,
all the while complaining about patient noncompliance…”

“… they (the doctors) would take the easy road, playing it safe by pandering to the desire for a technical fix, avoiding the difficult (adaptive) conversations rather than disturbing people in an attempt to change the ways they lived.”

Technical fixes to our profoundly broken health care system, such as the few I presented here, must be carefully weighed and balanced against the long-term benefits of more complex adaptive solutions.

We need to learn new ways; we need to be willing to engage communities, organizations and individuals inside and outside the system and to have those challenging discussions. We need to collaborate, take risks and adapt. We need to understand adaptive change and have the ability to get in the fray while also remaining above the fray. We need to let go of ego and attachment while positioning ourselves and others to do new and amazing things for the benefit of all.

We need to become the adaptive leaders we – and our patients – seek.

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