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Post-digital Health Leadership: Challenge and Capacity

Our board member, Dr. Tim Porter-O'Grady, contributed today's guest blog post regarding the importance of evidence (data)-driven decision making and service delivery to achieving the effective transformation of our healthcare organizations.

Recently, Michael Porter and colleagues have refocused our attention on the central attributes of a successful health system (1). Within the context of a value driven script, recalibrating the foundations of healthcare services ultimately means re-validating the central value of a healthcare system. The point they make is simple; patients and their families are looking for health, not treatment. While the message is simple, it implies a relative complex array of actions and intersections necessary to create those conditions in a meaningful way. From decisions at the social level about how we live, what we do, what we eat and what is sold to us, to personal choices we make with regard to individual lifestyle, relationships, stressors, and actions, all converge to create conditions affecting sustainable health.

All health professionals now realize that the script we've lived in the American healthcare system is neither viable nor sustainable. Yet, the challenges to change it and make it more relevant are, for most of us, overwhelming. Yet, at every level of the socio-political enterprise in America and within each component of healthcare service, dialogue regarding the need to transform health care is now moving quickly into increasingly substantive action. The question is no longer: will the health system change? It is, instead how will the changes look and what will work to create a value-driven and sustainable American model of healthcare.

This essentially means that every stakeholder at every level of society has a role to play in transforming the health equation and experience within the American culture. Political, business, social, and health leaders must now all converge around the construct and design of healthcare to reflect a truly value-based, cost-effective, and sustainable model for healthcare. This means that members of the healthcare workforce must consolidate their own efforts and begin to collaborate within the system and with the larger social community (patients, politicians, regulators, government, policy makers, etc.), to write an effective script upon which efficient, effective, and value-based health service might grow. This means, essentially, changing the relationship in most organizations between members of the provider community as well as altering the mechanisms for the work they do in a way that more clearly values collaboration, integration, collective wisdom, and team-based approaches to healthcare delivery.

The growing focus and construction based on principles of accountable care establish a different foundation upon which health practices emerge. Bundling service and payment around particular patient populations in a way that represents the construction of the appropriate architecture, information, integration, and clinical relationship necessary to advance quality healthcare is the driving centerpiece for the future delivery of health service. Healthcare leaders and managers must now recognize the centrality of point-of-service ownership and engagement in the creation of relevant clinical models that emphasize a local locus-of-control for practice while demonstrating the linkage between local practice across the continuum of care in a way that advances the health of the community.

Healthcare leaders and managers now must recognize and develop in their roles essential skills related to facilitating point-of-service, team based engagement and ownership models which center decision-making, problem-solving, and model building closest to the places where they will be exercised. Intersecting technology with human dynamics in the practice setting means that evidence-based practice becomes evidentiary dynamics reflecting an operating system that makes just-in-time clinical data available to the practitioner suggesting to her or him immediate adjustments in practice and care that require action now. Dense policy and procedure systems, management-driven control systems, ritualistic organizational standardization now quickly fall away immediately replaced with point-of-service decision support systems, immediate action feedback tools, and technology which continually supports the practitioner with portable up-to-date data reflecting the goodness of fit between action and outcome.

It is not a matter any longer as to whether these processes will unfold, it is simply a question of when and of readiness. Practitioners from registered nurses, pharmacists, physicians, therapists, technologists, and/or healthcare associates must certainly all realize that they have a stake and a role to play in reconfiguring health service delivery built on a health value equation and reflecting personal and professional ownership of impact evidenced by measures of sustainable health. Health systems managers and leaders now must realize their fundamental task is creating a context of engagement between the social environment and the health system, patients and providers, providers as the caring community, and the technical and operating infrastructure which supports us all in moving collectively and collaboratively toward effective and sustainable health. The leader's ability to develop skills in complexity and network management, interdisciplinary integration, point-of-service shared decision-making, and human - technology clinical interface will be critical in creating a supporting context sufficient to advance effective health service.

One thing that remains historically constant, even in our contemporary time, is the centrality of effective leadership. While the content and character of leadership has grown and transformed over the centuries of human experience and its expression continuously matured, its centrality to the success of organized human effort has never diminished. This holds true today. The content and expression of leadership has certainly transformed in the post-digital age but instead of eliminating the need for good leadership, our current challenges reaffirm its centrality to sustainability and success. However, in order to assure that leadership is valid and vital, the commitment to transforming expressive and applied leadership capacity must be continuous and dynamic. That, in fact, is both the price of entry into the role of leader and the demonstration of its continuing effectiveness even in this fast-paced post-digital age.

Porter, M. (2009).  A strategy for healthcare reform: Toward a value-based system. New England Journal of Medicine 361; 109-112, July 9, 2009.

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