The physician executive in a changing world - Physician Anger

Leland R. Kaiser

A NEW WORLD IS DAWNING. As a physician executive, you are standing on the threshold of the most breath-taking century in the history of our world. Our universe is changing in a profound way. Humankind is escaping the forces of natural evolution and is coming of age. We are about to remake our reality and our planet. We are becoming a self-designing life form. The self-designing person, working in a self-designing organization, living in a self-designing community, located on a self-designing planet--such is our destiny. And the good news is--medicine will play a key role in this important transformation.

Rather than adapting to an obsolete health care system, we are about to assume collective responsibility for reshaping it. Rather than being formed by external political and economic forces outside our control, we are about to assume internal control and shape those forces with vision and intent. The redesign of health care will create a gateway for redesigning society, since health Is the common denominator for everything we do in our communities.

Changing our mental model of the universe

It's all a matter of consciousness. At a low level of consciousness, you see the world happening to you and, as a result, you are always on the defensive. At a higher level of consciousness, you happen to the world and assume a proactive or design posture. The new century brings expanded opportunity to the health professions. Creating higher levels of community health and well-being is the 21st century challenge.

In answer to this challenge, we will soon begin building self-designing, self-sufficient, sustainable, and healthier communities. An emphasis on disease will give way to a focus on prevention, wellness, and human potentiation. Our existing resource shortage will become a resource abundance, as we learn to change our minds and, therefore, the world we live in. The old win-lose games of the competitive health care marketplace will be transformed into win-win games in a newly formed, more humane version of capitalism that serves both those with money and those without.

The key realization to be gained early in the next century is this--the only limitation we will ever face is the limitation of our own consciousness. Limitations are not "out there," but in here." All limitations, therefore, are self-imposed and can be overcome by changing our mental model of the universe. We live in a superabundant universe, but limit ourselves with our consciousness. We cannot have what we cannot Imagine. We cannot enjoy what we do not consciously create. The most important job of the physician executive, then, is to make his or her organization more conscious, and therefore able to escape its previous limitations. Changing personal, organizational, and community consciousness is the most important skill set for the future physician executive.

Parallel worlds

It is important to understand that you do not live in the universe. You live in your mental model of the universe. From the infinite abundance of things that could be, you select only a few to be and call your selection reality. In addition to the current world you choose to live in, there are an infinite number of parallel worlds you could just as well occupy. Some of them are much like ours--worlds of poverty, ignorance, crime, and disease. Others are those of great abundance, enlightenment, civility, and health. One parallel world is no more real, in an absolute sense, than another. They all exist as probabilities until you select one of them to become your chosen reality. The good news is--we as a society are about to change our collective mindset and, as a result, the universe we live in.

The United States will be the first nation in the recorded history of the planet to achieve self-conscious design capacity. We are about to reject our old mental model and the universe that goes with it. We are about to adopt a new mental model and enter a new world of health and health care. The physician executive will be part of this exciting change and will help physicians develop the attitudes and skills required to live in this new world. We are destined to become a designer planet and medicine is destined to become a design profession.

We are citizens of a multidimensional universe--a Plenum that knows no limitations and permits all possibilities. It is a giant reservoir of potential becoming. Since we cannot look into the face of such infinity with comfort, we construct limiting mental models, thereby reducing the vast waters of the void to a mere trickle. We live with a few drops seeping through closed mental faucets-all the while complaining about the shortage of resources for our hospitals and health care institutions. It is time to change mental models. It is time to open the faucet and experience the flow of an abundance economy. Collaboration, networking, volunteerism, third sector activation, utilizing new organic models, creating healthier communities, expanded approaches to community development--all of these and more will enable us to create a new world of health care for the 21st century.

Our role is reality selection

Often we act as though we do not know our role in reality selection. We assume that what is out there is the only thing that could be out there. It is enduring and inevitable--somehow outside ourselves and beyond our reach. We then attempt to adapt to our world, however bad it may be. Many physicians live in this kind of world, simply accepting the current disease level in the population and then trying to cure as many sick people as possible. The old mental model created physicians who were independent businessmen, largely autonomous, and expected to make the only and final judgments regarding the care of their patients.

The new mental model views the physician as a person with much less autonomy and as only one of several parties that can make judgments about patient care. In other words--physicians are losing their historic franchise as sole and primary providers of medical care. In addition to eroding moral and scientific authority, physicians are also losing income and status. It is no wonder that physicians are retrenching--confused and angry about the increasing marginalization of their profession and about society's changing expectations.

Physicians are caught in a transition zone between the world that was and the one that will soon be. This is a destabilizing zone and causes great anxiety. The question is--can physician executives do anything to help physicians better cope with the changing political, social, and economic environment? Can the current negatives faced by medicine become positives? Can physicians adopt and promote a new mental model that is exciting for themselves, their patients, and their communities? This article will attempt to answer those questions.

Need for a new mental model

Rather than being buffeted by changing social and cultural definitions of health care, physicians must become proactively involved in the future of their profession. Physicians need to help guide the evolution of the health care industry. They can only do this by offering a better mental model of health, medicine, and the community. This cannot be a defensive retreat from engagement. Rather, it must be an imaginative vision, vigorously set forth--a vision that will enlist the support of all constituencies involved in the effort to improve the health and well-being of all members of our society. The physician executive needs to work with physicians to orchestrate this effort to create a new vision of health in the 21st century.

The current situation in our health care industry was created by the old mental model. It is obvious, then, that we must change the way we think. We are limited not by the universe, but by our mental models. A new vision is needed that will Integrate all of our resources, permitting us to collectively move into our preferred future. In the new mental model, the community is viewed as a living organism, and community agencies are viewed as organs of that collective body. As in the human body, these organs (agencies) are connected with a nervous system (computers) and a circulatory system (resource sharing). What Is required, therefore, is a change of consciousness at the highest levels of the government, the marketplace, and the community.

Elements of the new model are:

Population-based

The old mental model was patient-driven, In the new model, the physician is based in the community and actively case manages the population. This means going out to the community and seeking to reduce population morbidity levels, rather than waiting for patients to come to the office for treatment.

Health rather than disease oriented

People want to live long and be well. This requires the physician to adopt a wellness orientation rather than a disease orientation. The new mental model goes upstream and attempts to reduce disease levels. Medicine becomes more of a design profession, rather than a fixit profession. The design objective is a healthy community.

Care partnering

The old mental model placed the patient in a submissive and dependent position. The physician was the expert. The patient was the passive recipient of his or her administrations and was expected to simply follow instructions. The new mental model views the physician as a mentor or coach. The physician and patient are on a journey towards greater health. The patient assumes as much responsibility as the physician for healthy outcomes of the joint interaction. The patient is expected to be well-educated about his or her disease and to fully participate as a partner in any treatment decision-making.

Integrated approaches to medicine

The future of medicine includes complementary and alternative modalities. The new mental model integrates them with allopathic medicine. The choice here is obvious. If physicians refuse to enter this arena, they will lose a lot of revenue, as well as the opportunity to provide a measure of safety for their patients. Consumers have already spoken. A majority of them are adopting the new modalities and simply choosing not to discuss their activities with their physicians. This is not a good situation for either party. Integrated medicine will be the norm in the 21st century.

Use of the Internet

Medicine is moving into cyberspace. Many patients are already there. Patient support groups constitute a strong and growing sector of the online community. The new mental model for medicine requires the physician to be computer literate, a participant on the Internet, and a major player on the hospital Intranet. Auto- mated email to patients becomes a major communications medium. In cyberspace, time and space limitations disappear and health care institutions are able to operate well beyond their geographic service areas. Physicians with distinctive services can easily do international marketing.

Importance of the spiritual dimension

The new mental model requires the physician to devote equal attention to the patients body, emotions, mind, and spirit--whole person medicine. The spiritual dimension will prove to be as important as the technological arena in future care giving. Healing will be integrated with curing. Treatment will be multidimensional and intervention will occur on many levels. A visit to a health care facility should be a life transforming experience. Disease is an invitation to larger being and provides an avenue for patient empowerment. An illness may create an opportunity for a better life. Birth, passage, and death are primarily human celebrations, not medical events.

Do these ideas seem strange to you? They come from the new mental model for health care that traces its roots to quantum physics and mythology. The new model recognizes a single source for both science and spirituality and the need for integrating them in healing health care. Do not confuse spirituality with religion. Religion refers to a doctrine or specific set of beliefs. Spirituality is a more inclusive term and includes all attempts to reach out and touch something larger than yourself. Spirituality provides a common meeting place for people of all religions and people with none, Spirituality is a key to health care in the 21st century.

It is time to alert your organization to the role of spirituality in generating organizational visions, writing mission statements, implementing transformational management, developing a community ethic for health care, and providing healing health care services to patients. In the 21st century, the health care facility is no longer viewed as a business. It becomes a sacred place, where patients and families gather to celebrate life and make new commitments to heal body, mind, emotions, and spirit.

Medical care becomes an experience enterprise

In the old model, the emphasis was on the physician's clinical interventions with the patient. The new mental model focuses on the patient's and family members' experience in the care facility and with the care givers. Clinics and hospitals are viewed as healing environments and are designed to provide amusement, inspiration, education, and empowerment. As cost and quality differences between surviving facilities narrow, patient choice will move towards those facilities providing the best overall life experiences. Indeed, health care facilities in the next century become experience enterprises. Physicians become dramaturgical figures acting out life episodes on the stages of their care facilities. Patch Adams is a good example of a changing mental model for what constitutes good medical care. Once again the media is offering us an early warning system for pending changes in the public mood and mental model. (Please see the sidebar featuring Patch Adams on Pioneering Solutions" on page 47)

Self-designing communities

A community is like a person. It has a unique past, a distinctive present, and a promising future. For a community to develop its unique resources and solve its most pressing health problems, it must go through a transformational process. Many American communities are ripe for transformation. The health problems they face cannot be solved with old thinking or traditional methods. Help is not coming from the federal government or the states. Rather, communities must empower themselves to act on their own behalf and generate change from the bottom up. Physicians need to become active in their local communities and help guide these efforts at community transformation, which will include redesigning the health care system.

Accountability for the future

The future is not something that happens to you. It is something you do, We are the creators of our future and, therefore, are accountable for It. The 21st century is the design century. America will achieve self-conscious design capacity. All of our social systems, including health care, will be redesigned to improve the health and well-being of the population. The new mental model views the physician as an architect for change and views the medical profession as accountable for the future of health and medicine in the United States. The future becomes something you invent rather than predict.

Going beyond the boundaries

Medicine has always been a bounded profession. Physicians are trained in a box and usually practice there for the rest of their lives. They expect to be well paid and cared for by their society. In return, physicians devote their lives and skills to healing their patients. Such was the old social contract and mental model. Now everything has changed. If physicians do not participate in a new role definition, they will get what is left over--if there is anything left over following the health care marketplace wars. It is time for doctors to get out of the box and cross old boundaries. Physician executives need to encourage their physicians to become actively engaged in community activities and participate in a variety of community betterment programs. The image of the medical profession is due for an overhaul. It is the rare physician that today spends much of his or her time in developing a healthier community.

Going beyond winning

The old mental model was win-lose. The new mental model is win-win. The downside of competition in the health care industry is now obvious to everyone. More people are uninsured than ever before and the gap between the medical haves and have nots is getting greater. We will soon hear the renewed call for a government-based single payer system as the underinsured become a political force for change. Coopetition will replace competition as health care providers work together on a number of community issues. The physician executive will develop new inter-organizational skills and will be extensively involved in networking. Former market adversaries will pool resources and accomplish visionary outcomes.

Forming strategic partnerships

Caring for patients, caring for our community, caring for our nation--these are progressive stages in the evolution of health care in the United States. The key to success as we focus on improving the health of our communities and nation is the formation of strategic partnerships. The future is about getting out of boxes, crossing lines, and building bridges. Old distinctions such as rural/urban, city/county, public/private, and tax exempt/tax paying begin to fade as we move into the post linear society of the new century. Networking, partnering, cooperation, collaboration, integration, deinstitutionalization, decentralization, regionalization, and the formation of virtual organizations represent the new dimensions of health care in 21st century America.

Going upstream

An important motto of the new mental model is never accept an unacceptable reality." There is too much crime, ignorance, poverty, and disease in our society. We must do more than simply try to fix them. We must seek to design them out of our society. The physician executive is challenged to help physicians transition from a "fix it" mindset to a design mentality.

The challenge is to design a healthier human habitat that generates health and well-being in its residents. To do this, we need a coordinated approach to open space planning, urban development, education, housing, employment, transportation, recreation, public health, medical care, law enforcement, and other important community subsystems. By going "upstream," a significant amount of disease can be designed out of a human population. Every community should become a living laboratory designed to test the upstream option.

No nation currently has enough resources to pay for the amount of disease it is generating. The only feasible solution is to reduce population morbidity. This requires a coordinated approach by private and public health. Since most physicians have not been trained for this type of collaboration, the physician executive must create a training program to give doctors skills in community intervention and community design. Only by doing this can we assure that the physician becomes an architect of health.

Empowering the group

In the old mental model, the center of action was the individual. In the new mental model it is the group. I The physician executive must learn to orchestrate group consciousness and generate consensual visions among the medical staff. This requires a new kind of transformational leadership and new organizational configurations. In the next century, vertical and horizontal organizational structures give way to circular structures. Organizational forms will become more virtual. Self-empowered work groups replace the old bureaucratic chain of command.

High performance organizations will dominate the future landscape of health care. When compared with traditional vertical hospital structures, these horizontal or virtual organizations achieve greater efficiencies, encourage more participation, generate increased quality, and promote shared accountability. High performance organizations require a change of mind and the adoption of new leadership attitudes and skills.

The new mental model is based on high-energy physics and fractal geometry. Metaphoric power replaces egoic and synergic power. The physician executive becomes a mythmaker and manages at symbolic levels. Since most physicians have received little or no training in group dynamics or organizational participation, physician executives must provide the needed training.

Learning to think system

The old world we lived in was episodic, fragmented, bounded, and discontinuous. The world we are creating is constant, joined, unbounded, and continuous. The new model views the universe as a system, within a system, within a system. Nothing stands alone. Everything is connected. Change one thing and you change everything. The new century physician must learn to think "system" and find his or her role and function as part of a community-oriented, integrated delivery provider network. Systems concepts, systems analysis, and systems design constitute the new lexicon of medicine. The physician executive manages system function rather than individual physicians.

Managing innovation

As medicine moves into cyberspace, high profile health care providers will attract customers from an international marketplace. The old limitations of a geographic marketplace are transcended. The question is--why would anyone fly to your institution for service? What do you do that is distinctive and different? The physician executive must work with the medical and nursing staff to provide distinctive products with enough unique appeal to draw people from many places. Such a reputation is already enjoyed by the Mayo Clinic. The waiting room at Mayo looks like the United Nations.

A formal R&D department with an approved funding line created by the board of trustees is a necessity to achieve high excellence in future markets. The issue is knowledge management, sometimes referred to as corporate intelligence. How do you manage the knowledge base of your organization? How do you assure you are on the cutting edge in each of your services? Knowledge management requires sophisticated computer skills, strategic site visits, and identification of and association with the small circle of people creating the state-of-the-art in each of your service lines.

Accessing the gift economy

Big visions require big dollars. Money will be harder to come by as our health care industry transitions through the final years of our price discounted competitive marketplace. Most health care organizations are in a period of resizing and retrenchment. What is a physician executive to do? The answer is simple--access the gift economy. You must learn to work with the philanthropic sector of our society. What great ideas do you have for your institution that will attract philanthropic dollars and volunteer help? How much do you know about fundraising and fundraisers? To what degree do you utilize physician volunteers or retirees in your organization? The gift economy can replace many of the dollars being lost. However, it will take time and talent to access this hidden resource. Most physician executives have little experience in philanthropy. Now is the time to make up this deficit.

Advancing technology

In the next century the world of health care will be driven by high technology. Gene therapy, molecular biology, new pharmaceuticals, biotechnology, bionics, microbotics, cell regeneration, artificial intelligence, nanotechnology, and holographic imaging will revolutionize health care. People will live longer and better. The health care GNP will approach 22 percent. High-touch medicine will join high-tech medicine as East meets West.

There is essentially no limit to the degree that medical technology can improve human life. This will come at a high price, but one that society is willing to afford for at least its more affluent members. Many technological breakthroughs will occur outside the United States. More of our citizens will travel to foreign lands to take advantage of them and to escape the purview of our regulatory agencies.

Aging population

As our society ages, a great premium will be placed on prolonging and improving the quality of life. This will carry us far beyond simple disease management into the potentiation of older adults. Prolongevity is a huge future health service. An affluent older population will demand and pay for prized new services. This is not the Medicare market, although in time many new services will be available there also, since seniors are becoming a progressively stronger political force in the United States. The physician executive should encourage the medical staff to go beyond the realm of geriatrics into the arena of Sage-ing, as it is now called. Any society with enough older citizens possesses the wisdom to transform itself. Older folks are more than a source of increased medical spending. They are a precondition of societal transformation, since most of them have escaped the fetishes and fixations of youth.

Conclusion

The physician executive and physicians in general are facing a rapidly changing world. Old mental models are not adequate for thrival in the new century. We can foresee many of the coming changes. We must act now to prepare ourselves to meet those changes and direct them in a way that will improve the health and well-being of the people we serve.

RELATED ARTICLE: THE CHALLENGE: HELPING PHYSICIANS MAKE THE LEAP TO THE FUTURE

How does the physician executive help staff physicians make the leap into the future? Any or all of the following methods will prove useful:

1. Establish an R&D department in your organization

Establishing an R&D department or function in your organization legitimizes innovative thinking. This select group of physicians, managers, and board members meet to design and develop innovative products for the future health care marketplace. The R&D function should be funded by the board as a percentage (5-7 percent) of the total organizational budget. The R&D department constitutes a safe political harbor for trying out new mental models and approaches to patient care.

2. Take your physicians on site Visits

Physicians learn best when they can observe and get "hands on" experience with new ideas and patient care practices. Site visiting is the most effective way to change traditional physician mindsets. The physician executive compiles a list of innovative sites and then arranges for a small group of physicians to accompany him or her to the site, observe, and ask questions. The site group then returns home with a whole new perspective and a mental readiness to explore alternatives that would never have occurred to them in their ordinary routines. Innovative sites across the United States are often five to ten years ahead of the rest of the country In a sense, visiting these sites is visiting the future.

3. Establish a journal/book club

A journal club is a good way of raising group consciousness. A small seed group meets periodically to discuss the future of medicine. An excellent selection of books is available on our changing political, social, and economic world. The group can explore new mental models and also be a source of personal transformation for its members.

4. Make sure your physicians are on the Internet

The Internet is the backbone for the development of planetary consciousness. Make a list of eye-opening sites and encourage your physicians to regularly visit them. If you wish, you can discuss some of the Internet sites in your journal/book club.

5. Bring in guest speakers

We change our minds as a result of someone offering us that possibility A guest speaker can create challenges and opportunities for new mental growth in listeners. The physician executive should establish a guest lecture/luncheon series for the doctors. This makes scheduling easier and creates the added incentive of the lunch and socialization.

6. Schedule organizational retreats

The best opportunity you have to help physicians change mental models is to get them into "total environments" away from the hustle and bustle of home and job spaces. A retreat setting is ideal for this. It is a microspace designed for intensive learning and cognitive and attitudinal change. The retreat needs to be carefully orchestrated to take the participants from where they are to where they may want to go. given the opportunity to do so. Socialization, recreation, and planned learning experiences are natural allies in consciousness raising.

7. Encourage personal development

Personal, professional, and organizational functioning are intimately related. Any physician undergoing personal transformation will show the resulting changes in professional functioning and organizational participation. The physician executive working with the organization can schedule a number of personal growth classes and make them available to the medical staff, organizational employees, and the community Some hospitals have established their own "universities" to do just that. If you want to prepare for the future, you must spend some organizational resources helping folks change their old mental models. Classes in lifework planning, change, spirituality healing, career development, futurism, community development, and self-care are possible topics in a developmental curriculum.

LEE KAISER'S READING LIST

The following books are on Lee Kaiser's consciousness raising reading list. You might want to consider some of these recommendations for your book club.

Anam Cara: A Book of Celtic Wisdom

by John O'Donahue

NewYork, NewYork: Cliff Street Books, 1997

A wakening Corporate Saul

by Eric Klein & John Izzo

Lions Bay, British Columbia, Canada: FairWinds Press, 1998

Awakening Earth

by Duane Elgin

New York, New York: William Morrow, 1993

A Brief History of Everything

by Ken Wilber

Boston, Massachusetts: Shambhala, 1996

Bridging Science and Spirit

by Norman Friedman

St. Louis, Missouri: Living Lake Books, 1994

Callings

by Gregg Levoy

New York, New York: Three Rivers Press, 1997

The Celestine Prophecy

by James Red field

Hoover, Alabama: Satori Publishing, 1993

The Choice: Evolution or Extinction?

By Ervin Laszlo

New York, New York: Jeremy Tacher/Putnam, 1994

Creating a New Civilization

by Alvin and Heidi Toffler

Atlanta, Georgia: Turner Publishing, 1994

Dancing the Dream

by Jamie Sams

New York, New York: HarperSanFancisco, 1998

The Dancing Wu Li Masters

by Gary Zukav

New York, New York: Quill (William Morrow), 1979

Doing Nothing

by Steven Harrison

New York, New York: The Crossroad Publishing Company, 1997

Evolution's End

by Joseph Chilton Pearce

New York, New York: HarperSanFrancisco, 1992

The Global Brain Awakens

by Peter Russell

Palo Alto, California: Global Brain, Inc., 1995

The Healing of America

by Marianne Williamson

New York, New York: Simon & Schuster, 1997

The Holographic Universe

by Michael Talbot

New York, New York: HarperCollins, 1991

The Last Hours of Ancient Sunlight

by Thom Hartmann

Northfield, Vermont: Mythical Books, 1998

Leadership and the New Science

Margaret Wheatley

San Francisco, California: Berrett-Koehler, 1992

Lucid Waking

by Georg Feuerstein

Rochester, Vermont: Inner Traditions International, 1997

Opening to the Infinite

by Alice Bryant and Linda Seebach

Mill Spring, North Carolina: Wild Flower Press, 1998

Out of Control

by Kevin Kelly

Reading, Massachusetts: Addison-Wesley, 1994

Partner Earth

by Pam Montgomery

Rochester, Vermont: Destiny Books, 1997

A Path With Heart

by Jack Kornfield

NewYork, New York: Bantam Books, 1993

A Pilgrim in Aquarius

by David Spangler

Forres, Scotland: Findhorn Press, 1996

The Quantum Self

by Danah Zohar

New York, New York: William Morrow, 1990

The Quantum Society

by Danah Zohar and Ian Marshall

New York, New York: William Morrow, 1994

The Radiance of Being

by Allan Combs

St. Paul, Minnesota: Paragon House, 1996

Reality Isn't What It Used To Be

by Walter Truett Anderson

New York, New York: HarperSanFrancisco, 1990

Reclaiming Spirituality

by Diarmuid O, Murchu

NewYork, New York: The Crossroads Publishing Company, 1998

Reworking Success

by Robert Theobald

Gabriola Island, British Columbia, Canada: New Society Publishers, 1997

Something in This Book Is True...

by Bob Frissell

Berkeley, California: Frog, Ltd., 1997

Synchronicity

by Joseph Jaworski

San Francisco, California: Berrett-Koehler Publishers, 1996

Synchronicity, Science, Myth, and the Trickster

by Allan Combs and Mark Holland

New York, New York: Paragon House, 1990

The Tao of Physics

by Fritjof Capra

Berkeley, California: Shambhala, 1975

The Truth About The Truth

by Walter Truett Anderson

New York, New York: Jeremy Tarcher/Putnam Book, 1995

The Turning Point

by Fritjof Capra

NewYork, NewYork: Simon & Schuster, 1982

The Web of Life

by Fritjof Capra

New York, NewYork: Anchor Books, 1996

Leland Kaiser, PhD, is President of Kaiser & Associates, a health care consulting firm in Brighton, Colorado. He is an Associate Professor in the Executive Program in Health Administration, Graduate School of Business Administration, University of Colorado at Denver. He serves as faculty for the American College of Physician Executives in the area of physician leadership. He can be reached by calling 303/659-8814 or via email at LKaiser@Kaiser.com.

COPYRIGHT 1999 American College of Physician Executives
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