Changes and even transformation to the US healthcare system are so needed. Past efforts to change the system, well-intentioned as they may have been, have proven a dismal failure. The proof is in the pudding with our current system remaining bloated, inefficient, overpriced, dangerous, and low-rated in quality of care compared to other modern systems. Our healthcare is more than twice as expensive as the average of advanced nations worldwide. Twice! Yet, the US is rated number 37 in the world in quality of care, just behind Costa Rica and just ahead of Slovenia. Obviously, whatever we have been doing to change healthcare for the better is not working.

It appears that a big factor in our inability to change and improve is related to the fact that most improvement efforts are driven top/down in the form of a never-ending parade of “programs”. Most of these programs significantly underperform or outright fail in their promise of major improvement, much less real transformation. Leadership’s response to this fact is to do more of what is not working or bring in a shiny new program. Note that little of this addresses improving the existing systems in place for delivery of healthcare, especially on the front lines where care is actually delivered. Here we get to the core issue.

Fact: Approximately 94% of the results we experience in healthcare, both good and bad, 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, especially where care is delivered. Because they are on the front-lines, nurses, and nursing, for the most part, must take the lead in creating the much-needed transformation of healthcare.

Nobel Prize Winning Science at Work in Healthcare

Nobel Prize-winning science shows us that systems that resist change in a changing environment (think healthcare) become stressed and less efficient. We learned that these stresses in systems are passed on to those who have to work in those systems. Now we have stressed systems, stressed people, high costs and poor outcomes, both for patients and care providers. Let’s look at how we might use these stresses to speed change for the benefit of patients, care providers, and the organization.

In order to create better outcomes in healthcare, it becomes clear we must upgrade the systems to produce the desired results. This requires that leaders and managers grow and expand their skill sets to include systems thinking and regular use of system optimization tools in their roles as leaders or managers. Also, we must begin to work where care is actually delivered. This means the strategy for creating the transformation we so desperately want and need will be more bottom up than top down and become more of a way of being than a program to be done. Lastly, nurses and nursing must take the lead in this systems-based transformational model and allow their successes to spread organically across and up through the organization.

Here are a few of the outcomes created primarily by nurses and front-line care providers optimizing their systems of care delivery. Notice how the improvement on the front-lines has positively affected all aspects of the organization:

To learn more about this new model for healthcare and business transformation, 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 www.thenewagreements.com. Also, ask us for a flyer at info@thenewagreements.com describing the New Agreements Online Tools Training, which is at the heart of these improvements.


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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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