Bankrupting America – Fixing Healthcare In the US

An Interim Step

Change in our bloated, inefficient, overpriced, dangerous, low-rated healthcare system is coming. It has to. The current direction of the existing system is not sustainable for the system itself and also for our country. Our healthcare is more than twice as expensive as the average of advanced nations worldwide. What do we get for this astronomical cost? Not nearly enough. In fact, the US is rated number 37 in the world in quality of care, just behind of Costa Rica and just ahead of Slovenia.

In 2017, healthcare in the US was 18% of GDP and still rising. 18%! What might be the core issues driving this miserable situation? I think there are three: for-profit motives, poor systems and processes, and poor leadership and management.

We are the only for-profit system in the developed world. This means that all vested interests are doing all they can to keep profits high while reducing their costs of goods and services. This usually means keeping prices high in an inelastic market. It’s the capitalistic way; less for you and more for me, even if the customer dies in the process. Drug companies, insurance companies, medical equipment makers, distributors, hospitals, physicians, and politicians—you name it—everyone has a hand in the cookie jar.

I’m an entrepreneur and a capitalist but not a big fan of the crony capitalism that is driving wealth inequality and the destruction of the US middle class. Healthcare is a symptom of crony capitalism at its finest. Okay. That’s not going to change in the short-term. So, what are we going to do to shore up healthcare so we don’t bankrupt anyone who gets sick or kill or ignore anyone who can no longer afford healthcare, insured or not?

The longer-term fix appears to be a single payer system that brings the current vested interested to heal. However, it appears there may be an interim step that keeps the country from going bankrupt over healthcare costs and paves the way for whatever the new system might be. In general, the two biggest corrupters of company cultures are poor systems and poor leadership and management. Healthcare has both. Let’s start with the poor systems issue and the following fact:

Approximately 94% of the results we experience in the workplace are a function of the systems and processes in which people work, not the efforts of people. How many leaders and managers in healthcare know this? Not many. If we want better results, including better outcomes for patients, frontline care providers, and the bottom line, we have to fix legacy healthcare systems/processes.

Nobel Prize-winning science shows us that stresses in systems that resist change in a changing environment (think healthcare) are passed on to those who have to work in those systems. Now we have stressed systems, stressed people, high costs and poor outcomes. This is four strikes against the US healthcare system. But there are a couple more strikes as well.

Legacy leadership and management in healthcare, for the most part, is comprised of systems illiterate individuals in mostly top/down and often fear-based cultures. Most are living in an obsolete but unquestioned management model. This model is burning up healthcare providers, especially on the frontlines where care is actually provided.

In order to create better outcomes in healthcare, it becomes clear we must upgrade the systems to produce the desired results and expand the thinking of leaders and managers to include systems thinking. Some of you might be thinking, Okay. Sounds good. Now what?

I suggest that progressive healthcare organizations, as an interim step strategy, implement the four New Agreements for Leaders and the 7 New Agreements Tools. These New Agreements and 7 Tools have proved quite effective in fixing systems, relieving stress on people, creating much better outcomes in the areas of quality of care and safety and significantly more profit. I believe for large hospital systems, profits could easily rise 25% or more while providing better, safer healthcare. For smaller hospitals, the rise likely would be greater. That’s been our experience in implementing the Agreements and Tools in healthcare organizations.

To learn more about The New Agreements and the 7 Tools, pick up a copy of my book, The New Agreements for Leaders – The 4 New Agreements and 7 Simple Tools that Develop Emerging Leaders and Managers and Grow Great Organizations. It’s free at

David Dibble
As a 24-year-old, I founded a company with $5000 and built it into a $10M business with 200 employees. I was an early adaptor in the quality movements of the late 1970s and early 1980s, often speaking to business groups on the subject. Since 1990, I’ve been doing consulting and training, teaching leaders and managers how to be better in their roles, resulting in much higher performing businesses. My life’s work is embodied in The New Agreements for Leaders training, a systems-based paradigm shifting leadership and management model that creates significantly more value in businesses than traditional models. My latest book (I’ve written five) is The New Agreements for Leaders. The engine for implementation of this model is the 7 Tools for emerging leaders and managers. Importantly, the use of 7 New Agreements Tools for leaders and managers actually grows good and even great leaders and managers. For eight years, I worked directly with don Miguel Ruiz, author of the best selling The Four Agreements and prior to that studied both the physical science of change and the spiritual science of transformation. I’m now living in Napa with Linda, my wife of 46 years, so we can be close to our children and grandchildren. I’m learning to drink wine out of a glass rather than a pitcher and still enjoy a bad round of golf now and again.
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