Newtown, CT – July 3, 2015
In a Greek tragedy, there's always a lesson to be learned – Much like Napoleon's Grognards – his fierce Republican Guard – in the face of certain defeat, the Greeks have decided to say "merde" to the rest of Europe. At some level, both Grognards and Greeks feel that there is glory in certain death, defying the odds and showing one's metal. But there is no glory in an early demise, just a wasted life. As Jack Welch once said: "Control your destiny or someone else will," and by refusing to take the reasoned approach, both Grognards and Greeks surrendered their destiny to others. When the forces of change have finally shifted the tide of the prior status quo, adapting to the new current is, in fact, the only way to control one's destiny. The Grognards didn't want to admit or believe that the Napoleonic era had come to a close, and the Greeks don't want to admit or believe that their welfare state cannot continue to be financed by debt. There are similarly, those in U.S. health care that can't see the tide of change that transparency, value-based payments and consumerism has already brought about.
What this means to you – There are always holdouts in any paradigm shift. It's to be expected. Some will realize sooner than others the depths of change and its meaning to their soon to be defunct business models. Others will hang on, say "merde" and get slaughtered. The Greek tragedy that is unfolding today shows, however, the difficulty of changing cultures, and how much we always underestimate the wrenching effect that shifting tides have on those that have been led to believe that it's only a passing phase or that they are an exception. That's why today's health systems, hospitals and physician organizations have to look deeply into the culture of their organizations and understand which portions of it must be jettisoned and which can be kept. At some level, the leaders of these organizations have to unleash an entrepreneurial spirit within the context of excelling at patient-centered care. Every department, every service line should strive to be a center of excellence, not simply competing against other internal departments and service lines but, more importantly, external ones. Those that can't compete should be shut down, or significantly re-engineered. There can be no sacred cows, no protected or insulated domains, because any internal holdout risks polluting the rest of the organization with a counter-culture to the new one. In Greece, the public sector has long been considered a protected domain, with pensions, benefits and other advantages that are significantly better than the private sector's. The largesse for that protected class has come at the expense of every day workers, and at the expense of the country's future. The bill is now due and will have to be paid. The culture shift will be wrenching, perhaps bloody, and certainly painful. Their destiny is in the hands of others, and therein lies the lesson for all the current leaders of healthcare organizations: do what you must, or it will be done to you.