Constructive Dissatisfaction with the Status Quo

In my previous post, I shared that the ideal care model team is focused on our patients’ needs in between visits with a clinician. Instead of focusing mostly on the patient in front of us, we need to “see” to the entire population attributed to us. That helps us determine how and which resources to dedicate to events that occur outside of the office visit (i.e., invisible) or to patients who have not shown up (literally, who are not “seen”). This is one of the most consequential conceptual changes LCHC faces in the new model.

In the past few weeks, we have served several patients in the dojo, to learn directly from real-time work in our practice environment while simultaneously addressing the patients’ needs. The explorations have been wide-ranging and fascinating: from the best way to entice and engage the patient, to the most supportive way to interact and link to needed services and resources, to communicating amongst various team members including the documentation that represents the patient’s story. There are always many opinions on the way forward, but no clear-cut solutions yet.

At the heart of the lean management philosophy, a central belief is that the current condition is always the starting point from which to improve (i.e., the worse possible condition is ripe for improvement!). You have never arrived, so there is the constant pressure to continuously improve the work for the sake of our patients, as well as for ourselves. This constructive dissatisfaction is an authentic desire to make things better, fueled by an optimism for what is possible. This journey brings us closer to fulfilling our mission and to living our shared values.

Yet, although there is consensus that almost everything needs to be improved, when engaged in the actual design of change, we still gravitate toward the comfort of the current state with all its flaws. For instance, even though documentation is a perennial complaint by providers, any attempt to change is met with any number of reasons why certain aspects need to be preserved.

Change management is a whole field of study, so I thought I would restrict my observations to our corner of the universe, at LCHC. Beyond the obvious – desire for control, personality conflicts, fatigue from overwhelming daily work, lack of contextual understanding, non-ideal communication from and to leadership –, I believe most of the resistance stems from the following.

Having operated in a chaotic, non-patient centered environment all our professional lives, we strive to maintain control so as not to lose the workarounds we have implemented to survive. My friend and mentor, Dean Cleghorn, used the metaphor of the health center as a black hole. Those of us who remain manage to do so by designing our own orbit around the black hole, close enough to perform our work but far enough not be sucked in and destroyed. The fear is that we will get knocked off our orbit by well-meaning but generally insufficient efforts to improve. Past partially unsuccessful efforts lead to a paralyzing distrust of leadership’s vision and each other’s dedication.

Here is my challenge to you:

• Come practice and learn in the dojo. In the meantime, get context: read my blog, engage in your team and your guild’s discussion around changes, read the weekly executive team newsletter, pay attention to media coverage of upcoming changes at the state and federal level.
• In the dojo, be prepared to provide your insights on how to incorporate ideas to improve the current design of the ideal care model. Improvement must be an iterative process, in which each cycle informs the next one. LCHC will not get this right the first time; in fact, I can guarantee that the first few cycles will be filled with errors and obstacles. Yet, if honest effort is put into this design, it will be better than what we offer patients right now.
• Think! Imagine! In a different environment, what are the services you wish we offered patients? What are the processes you feel need the most improvement? Which ones are the easiest to improve?
• Do not shy away from mistakes or problems: every error is an opportunity.

As a global citizen who has experienced both incredibly well-designed societies (Switzerland, college) and poorly designed ones (the United States health care system and the Congolese infrastructure), I have long been fascinated with the process of change. Organization and design are the backbone of human achievement. At LCHC, it will allow for the ambitious mission to daily get closer to a lived reality. I will miss struggling to find the best ways to lead LCHC forward, and with my efforts to bring lean, social justice, the respect of dignity and empowerment into daily life at the health center. Much gratitude for accepting my leadership over the last few years, for patiently tolerating my learning curve and for the admirable dedication with which you approach your work.