An Observer’s Advice to Vermont on Health Care Reform
As I listened to the presentations and heard the questions that the conference participants were asking of one another, I would have enjoyed nothing more than to join their conversation. I held my comments to myself, but had I spoken there would have been many things that I would have said.
- First and foremost I would have saluted them for the progress that they have made. I was impressed with the clarity of their overall vision and the understanding and cooperation within state government and between state government and high levels of healthcare leadership that have allowed Vermont to get this far on the road to health care reform.
- Second, it is remarkable that they have fostered a conversation over several years that has led to a critical mass of leaders who have an understanding of the challenges ahead. Lean management principles teach that the square root of “n” is the number of leaders compared to the number of people in the whole organization needed to foster change. If “n” is 100 then 10 leaders are needed. I do not know the total number of physicians in Vermont and I feel that “n” in a healthcare system includes all of its employees and participants. There is therefore a continuing need to communicate and educate all those who participate in the delivery of care in Vermont. Some critical number must “care why”.
- Thirdly, the system must work with Vermonters for their benefit. Finding others from the community who can articulate an understanding of the objectives of healthcare reform like the Green Mountain Care Board chair, Al Gobeille, is a challenge that must be meet. The audacious goal would be for all Vermonters to understand the objectives of good care and its importance to their community, and then trust but hold accountable those whose task it is to give them good care. At a minimum there must be a continuing conversation about community benefit. It would be nice if it could also extend to education.
- Finally, I would urge them not to be discouraged by the natural pace of progress. Good ideas emerge. Some work out, some do not, but any effort reduces the level of ambiguity about the possible. Governor Shumlin’s retraction of “single payer” after four years of discussion is a great example of this reality. “Strategic deployment” is part of a process of continuous improvement. The dream of better care and the tools to effect that dream will require Vermont to think of itself as one enterprise and adopt an organizational operating system for that enterprise. There are good examples to learn from. I am thinking of Denver Health and the recently renamed New York Health and Hospitals Corporation, NYC Health+ Hospitals. Both organizations have transformed the care of large populations using Lean culture and tools.
I could go on. Vermont’s future success depends upon the continuing great leadership that they have and the cultivation of more leaders who are aligned with the vision and goals of the original Blueprint and the subsequent evolution of thought from the experience gained on the journey.