Honor knows no statute of limitations. ~ Samuel E. Moffat
The bar was dark, loud and smokeless. 
The table set with a glass of pinot noir and a non-alcoholic fruity beverage.
The voices of the two healthcare quality leaders were hushed but steady.
“Once we have a financial model in place, our ability to improve healthcare provision will be much more attainable.”
“It requires a financial model to be in place prior to doing the right thing? We cannot wait. Patients are being wounded. Families are being harmed. Communities are being hurt. Over 50 percent of inpatient adverse events are preventable. The harm rate in healthcare is staggering. Yes, a financial model aligned with our aims is important, but doing the right thing should not be dependent on it. We need to identify those people who truly value patient safety--those people who are not reliant on a new financial incentive to do what is right, those people who truly care--and ensure they are positioned to both lead and serve in an effort to improve the healthcare system. A financial model is important. It is also a technical fix to an adaptive challenge. We cannot wait.”
“Tom, I agree. We must do both. I just know that the system will not change until we align the financial drivers.”
“And yet the pendulum has swung from fee for service to fee for service with withholds to capitation (primary care cap, specialty cap, contact cap, global cap) to quality based incentives (now called pay for performance) back to fee for service but now married with P4P models, and so on and so on. And in each instance maximizing revenues and market share has become a keen focus for many. It has become a game. How about we do what is right first? The opposite has been tried and failed too many times and too many people have been hurt far too often.”
“True. And yet to turn this ship we must get the financing right.”
There are a great many people of value, of integrity and of honor within the healthcare system who strive each and every day to do what is right for patients, families and communities as well as for doctors, nurses and staff throughout the system.
These are the people we must engage.
These are the people we must ensure are at the proverbial table, be it the health system board, the leadership teams of the hospitals and medical groups, the local health and/or healthcare non-profits, and so many more.
These are the people who, when the funding model changes, their values do not.
These are the people that when times get tough, they lean in to do what is right rather than bail out and take an easier, more lucrative role.
These are people who are like the many physicians I have been blessed to know who left lucrative practices that “steal their soul” to focus on innovating the healthcare model so that patients and families are truly embraced, whole stories truly heard and honored, and treatment plans co-created and aligned with patient preferences. And they have done so even though they are not maximizing their individual revenue.
These are people like the many nurses I have also come to know who don’t even take breaks to go to the bathroom as they focus 100 percent of their daily efforts to care for patients and families, as well as doctors, staff and one another under challenging circumstances at best.
These are people like the physician assistant I have mentionedpreviously, who risked her job to find a solution to emergency room overcrowding--which did not include spending limited capital on more bricks and mortar with a goal of financially maximizing ER visits.
Yes, system improvement (i.e., an aligned financial model) is essential to an optimal healthcare model. And yet, at this time, it is not as important as identifying and leveraging those who are both within the system and outside the system who embrace the values highlighted throughout this post.
We must ensure these individuals are whole and healthy, and help position them so that they may lead and serve with great joy using their skills, wisdom, gifts and passions for the betterment of society.
The greatness of a man is not in how much wealth he acquires, but in his integrity and his ability to affect those around him positively. ~ Bob Marley
Thomas H. Dahlborg, M.S.H.S.M., is an industry voice for relationship-centered compassionate care and servant leadership. He is a keynote speaker, author, consultant and adviser and is the president of the Dahlborg Healthcare Leadership Group.