Leaders can be Great Teachers
On November 13, Secretary Mike Leavitt gave a keynote address to approximately 2,000 health information technology leaders attending the American Medical Informatics Association (AMIA) annual meeting. Aside from the security personnel scanning the audience, one did not get the feeling one was hearing a keynote as much as one had the sense one was in a classroom. He asked the participants to write down key phrases on paper (e.g., "national standards, local control"). He asked participants to draw a map of the country and to identify their community and several other communities they favored and think through with him how each community can retain its identity, advanced based on its own situation, yet conform to areas where standards make sense. As a Chicago analogy, he pointed out that Cubs and White Sox fans may disagree on who has the best team, but they all share the rules of "three strikes, 9 players, and the like." (The "designated hitter" remains an area of standards controversy.)
Secretary Leavitt is a great teacher and communicator. Over time, his ideas have gelled. In particular, the use of the term "value exchange" is an important one because it implies there is more to value than dollars or convenience. Although executive orders force agencies at times to prematurely define terms best left to social evolution (and both "value" and "quality" are in this writer's view these types of terms), the overall HHS formulation of the problem is a good one.
Still, it is a matter of execution. Were the government to focus the debate and frame the questions only, one would have great success. But given the complexity and passion with which every professional involved in health care addresses these questions, we are at present left with a diffuse, over-extended, complex array of working groups, sub-committees and other processes that both impair attention on the most important "quick wins" and, to many cynics, substitute debate over health information technology for the far more critical debate on the very nature of our health care delivery and financing system. At least one individual near this writer said to a colleague during the talk "they are just talking about technology because they can't agree on how to fund health care."
This writer has been critical of the execution of many technology initiatives at the federal level. Each effort - when viewed alone - seems rational in aim if not in time to results (i.e. arriving at what a PHR really is will be an ongoing process over many years, not something executed by contractual fiat or AHIC consensus statement). It is when you put all of the myriad working groups and committees together that it gets confusing. To paraphrase a theological scholar and reviewer, it is as if we have a soccer field with six teams and four balls. Everyone is very actively engaged in running about and kicking, but from the stands, the game makes no sense whatsoever.
The Secretary has the skills and the opportunity to address theses concerns. He can set the rules and move from a diffuse agenda to a more focused one. He can use a newly rejuvenated ONC - now truly committed to "coordination" with other federal, state, and local agencies - as well as the broader apparatus to trim down the debate, put half or more of the working groups and certification groups on the back burner of deliberation, engage established groups, and focus the attention of the entire nation on a few efforts that would give hope that the federal government can do something more than consume time and money. This does not relegate all local action outside of these areas to a backwater, but merely acknowledges that many local issues - even in areas of standards - will logically reconcile over time.
It is regrettable that so many say this Administration is focused on what will make a difference before the next election cycle. These are the cynical realities of American politics. But I think most of us hope to be alive after the election, and the same goes for our family and friends. We will have medical problems, we will have financial challenges; the realities on the ground won't be that different. No matter which party sits in what post in two years, this writer believes the electorate more than anything else wants assurances that our country is making every effort to create a stronger America grounded in personal and fiscal responsibility, united in compassion, and committed to open and non-judgemental debate.
The very best leaders find a way to accomplish something tangible in a short period (my candidate would be effective medication management or as it is often called "e-prescribing). The very best also find a way to shift the perception and to engage the public in a more long-term process of reflection and debate based on asking the right questions. One of these questions is not "who should pay for my health care" (since no one can afford it, really) but rather, "how can I work with others in my family and community to make health care more consistent, effective, affordable, and of higher quality"?
As this writer listened to the Secretary, he was watching a master teacher taking a group through a set of lessons. Like any great teacher, all the Secretary can really hope for is that some of his ideas become the ideas of those in the room and that people act on what they now to believe to be their personal inspiration.
Where the spirit of national standards and local action is concerned, agents of the federal government should realize that the very best "students" don't do just what they are taught but improve on what they learn and make good ideas more actionable within a local environment.
This writer is very glad his teachers don't try to "certify" his life based on what he learned in past decades but instead both trust and hold responsible their student to modify and transform life goes on. The Ten Commandments seem to hold pretty well as standards, but I am not sure about dress codes, speed limits, and man other details.
This writer would do a better job of following through the spirit of his teachers in government if he were assured there were a few critical and realistic short-term and long-term goals that transcend both electoral cycles and partisan interests. We cannot predict the future, but we should be able to count on the values and capabilities of one another if we work towards common goals.
Secretary Leavitt is a great teacher and communicator. Over time, his ideas have gelled. In particular, the use of the term "value exchange" is an important one because it implies there is more to value than dollars or convenience. Although executive orders force agencies at times to prematurely define terms best left to social evolution (and both "value" and "quality" are in this writer's view these types of terms), the overall HHS formulation of the problem is a good one.
Still, it is a matter of execution. Were the government to focus the debate and frame the questions only, one would have great success. But given the complexity and passion with which every professional involved in health care addresses these questions, we are at present left with a diffuse, over-extended, complex array of working groups, sub-committees and other processes that both impair attention on the most important "quick wins" and, to many cynics, substitute debate over health information technology for the far more critical debate on the very nature of our health care delivery and financing system. At least one individual near this writer said to a colleague during the talk "they are just talking about technology because they can't agree on how to fund health care."
This writer has been critical of the execution of many technology initiatives at the federal level. Each effort - when viewed alone - seems rational in aim if not in time to results (i.e. arriving at what a PHR really is will be an ongoing process over many years, not something executed by contractual fiat or AHIC consensus statement). It is when you put all of the myriad working groups and committees together that it gets confusing. To paraphrase a theological scholar and reviewer, it is as if we have a soccer field with six teams and four balls. Everyone is very actively engaged in running about and kicking, but from the stands, the game makes no sense whatsoever.
The Secretary has the skills and the opportunity to address theses concerns. He can set the rules and move from a diffuse agenda to a more focused one. He can use a newly rejuvenated ONC - now truly committed to "coordination" with other federal, state, and local agencies - as well as the broader apparatus to trim down the debate, put half or more of the working groups and certification groups on the back burner of deliberation, engage established groups, and focus the attention of the entire nation on a few efforts that would give hope that the federal government can do something more than consume time and money. This does not relegate all local action outside of these areas to a backwater, but merely acknowledges that many local issues - even in areas of standards - will logically reconcile over time.
It is regrettable that so many say this Administration is focused on what will make a difference before the next election cycle. These are the cynical realities of American politics. But I think most of us hope to be alive after the election, and the same goes for our family and friends. We will have medical problems, we will have financial challenges; the realities on the ground won't be that different. No matter which party sits in what post in two years, this writer believes the electorate more than anything else wants assurances that our country is making every effort to create a stronger America grounded in personal and fiscal responsibility, united in compassion, and committed to open and non-judgemental debate.
The very best leaders find a way to accomplish something tangible in a short period (my candidate would be effective medication management or as it is often called "e-prescribing). The very best also find a way to shift the perception and to engage the public in a more long-term process of reflection and debate based on asking the right questions. One of these questions is not "who should pay for my health care" (since no one can afford it, really) but rather, "how can I work with others in my family and community to make health care more consistent, effective, affordable, and of higher quality"?
As this writer listened to the Secretary, he was watching a master teacher taking a group through a set of lessons. Like any great teacher, all the Secretary can really hope for is that some of his ideas become the ideas of those in the room and that people act on what they now to believe to be their personal inspiration.
Where the spirit of national standards and local action is concerned, agents of the federal government should realize that the very best "students" don't do just what they are taught but improve on what they learn and make good ideas more actionable within a local environment.
This writer is very glad his teachers don't try to "certify" his life based on what he learned in past decades but instead both trust and hold responsible their student to modify and transform life goes on. The Ten Commandments seem to hold pretty well as standards, but I am not sure about dress codes, speed limits, and man other details.
This writer would do a better job of following through the spirit of his teachers in government if he were assured there were a few critical and realistic short-term and long-term goals that transcend both electoral cycles and partisan interests. We cannot predict the future, but we should be able to count on the values and capabilities of one another if we work towards common goals.
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