03/24/2010 05:12 am ET Updated May 25, 2011

Mass. Confusion in Health Care

As I looked out the window in Massachusetts this morning, everything seemed the same. But, from what I read and hear, everything changed on Tuesday night. That's confusing.

The confusion started as a red Republican, Scott Brown, threatened to take Ted Kennedy's bluest-of-blue, Democratic Senate seat. Then, on Tuesday, it happened - Brown won. Now, it's Mass. Confusion as the Boston Globe headlines "A New Political Landscape," and the Wall Street Journal quotes a Senate aide saying, "People are hysterical right now."

But is everything really so confusing? I propose that kind of thinking is a big part of our current health care problem. For lack of a better term, let's call it Mass. Health Care Confusion. Here are some examples:

Mass. Health Care Confusion #1: The big health care problem requires a big solution.

I agree with President Obama: "The biggest threat to our nation's balance sheet is the skyrocketing cost of health care." That's a big problem. It's the "big solution" answer that I question.

I have been in health care for 40 years and "big problem = big solution" has always been the health care expert's mantra. But those "big solutions" not only haven't worked, they've become part of the problem (see When Healthcare Solutions Become Problems)

H. L. Mencken once said, "For every difficult and complicated question there is a answer that is simple, easily understood ... and wrong." If you think that way, it's all a little less confusing.

Mass. Health Care Confusion #2: Health care needs a big, quick, political solution.

Adding politics into the "big solution" equation increases the confusion, makes it more challenging to find answers and more burdensome to govern.

For example, prior to his election President Obama campaigned heavily to allow Americans to purchase lower-priced, FDA-approved medicines from overseas. That's not a bad idea, but his administration eliminated that initiative from health care reform. Why? - "It's about being a candidate as opposed to being a president," said the drug industry's top lobbyist (See Candidate Flip, President Flop) . The White House commented that disenchanted activists "need to take off [their] pajamas, get dressed, and realize that governing a closely divided country is complicated."

I find that comment refreshingly frank. Political realities are big complex problems in and of themselves. It all becomes less confusing when you realize that combining two big, complex problems like health care reform and politics together, makes it that much more difficult to find solutions and govern effectively.

Mass. Health Care Confusion #3: Obama and the Democrats are wrong and the Republicans are right.

That's just another simple explanation to a complex problem and just as wrong.

The accelerating cost of health care and the uninsured are crucially important issues. The Rush Limbaugh-types and others who use any and every Democratic policy initiative to inflame partisan ideologies or the apologists who chant "our health care's great" only add to the confusion.

It decreases the confusion when we realize politics and health care did not radically change on Tuesday night, only the realities of both became much more obvious. This is an opportune time to reduce the confusion and find common ground in the center of both parties to generate policy that can really make a difference for patients.

We can further decrease the confusion by being more specific about the problems and potential solutions. Here are my thoughts:

The way we are currently practicing, managing and governing health care is delivering much less care at much more cost, and it's getting worse. We can't afford that trade-off for economic and humanitarian reasons. That's a big problem with many causes. Experts have designed big, top-down health care solutions for forty years. They haven't worked. Add politics into the equation and it only gets more confusing. We need an alternative.

So what's the answer? Health care needs to transform and, in my and others' research, industry transformations follow a predictable course: a few leaders progressively adapt their organizations to deliver what the rest cannot. Toyota did not design and implement the Toyota Production System or the downfall of GM; they made it through constant adaptation. Southwest Airlines did not design and implement the world's most profitable airline; they made it in a similar fashion. Those are just two of hundreds of examples.

Health care transformation begins with those few organizations that become strategically and operationally "designed to adapt." They gain advantage in a rapidly changing world by adapting to create innovations that deliver more care for less cost. Here is how it works:

  • Set the direction - clear, simple, consistent, patient-focused.
  • Develop people, not technology, as the number one resource.
  • Rapidly problem-solve patient needs as part of everyone's daily work.
  • Use results for patients to build trust, optimism, local knowledge and ingenuity to turbo charge success.
  • Repeat and spread success by opportunistically and relentlessly attacking the status quo.

The seeds for this transformation are already planted. Rather than designing and implementing the answer, a few health care organizations are seeking to build organizational DNA that is "designed to adapt." We need to nurture and spread those seeds (see Beyond Politics - Making a Difference in Healthcare Now)

Both government and the health care industry have become wedded to leading "big fixes." Too often that becomes a confusing, discouraging "flavor-of-the-month" at the point of care. We will eliminate confusion in challenging times when leadership revitalizes trust, optimism, high-performance and innovation that makes a difference for patients.

Government has a crucial role to play in an adaptive health care reform. Confusion can be diminished by policy initiatives that create safe-harbors for innovation at the grass roots level and eliminate obstacles and barriers to improvement. That's the way government has always successfully facilitated significant social and economic change. That will help eliminate Mass. Health Care Confusion and start to make a difference for patients.

Dr. John Kenagy is a physician, patient and former Visiting Scholar at Harvard Business School who speaks and advises on health care transformation focused on the patient. His recent book is Designed to Adapt: Leading Healthcare in Challenging Times. For more information, see