1. Health Care
Reform: Five Miles
Gone…A Long Way
Home
Edward O’Neil, PhD, MPA, FAAN
O’Neil & Associates

2. How we wish we could lead
change…

3. 3

4. How it really is…

5. Change
5

6. L = Vision + Task + Relationship
6

7. Level Set: Three Drivers
Why can’t we change?
•US spends 1/ more
3
7

8. Big Challenge

9. Transition
Tomorrow
•
Chronic prevention and
management
•
Pay for value
• Pay for transactions
•
Price competitive
• Cost unaware
•
Consumer responsive
• Professional prerogative
•
Ambulatory – Home and
Community
Today
PPACA
HCERA
• Acute treatment
• In-patient
Strategic Success
• Team
• Individual profession
•
•
• Traditional practice
• Information as record
• Patient passivity
Market
Evidence based practice
Information as tool
•
Consumer engagement and
accountability

10. US Health Care: Four Options
•Drive it less- ration
•Shift the costs
•Pay less for it- controls
• Expensive
• Overbuilt
• Underperforming
•Build a new chassis

11. Human Cussedness

12. Paradigms
80
70
60
Productivity
• Effective tools
• Make things work
• Provide
coherence
• Eventually, limit
what we think we
can do
• Eventually stops
working
50
40
30
20
10
0
Inputs

13. The Paradigm and Benefits of the SQ
Health Professional work
has provided:
•Worthy, fulfilling work
•Social meaning
•High social status
•Prestige
•Independence
•Good Incomes
And, at its very heart,
Meaning,
Self-definition and Identity

14. Add These Numbers

15. Add These Numbers
1000

16. Add These Numbers
1000
40

17. Add These Numbers
1000
40
1000

18. Add These Numbers
1000
40
1000
30

19. Add These Numbers
1000
40
1000
30
1000

20. Add These Numbers
1000
40
1000
30
1000
20

21. Add These Numbers
1000
40
1000
30
1000
20
1000

22. Add These Numbers
1000
40
1000
30
1000
20
1000
10

23. Add These Numbers
1000
40
1000
30
1000
20
1000
10
=
4100

24. What is a New Practice Model?
What Changed?
•Professional role
•Management of information
•Sequencing of care
•Engagement of consumer
•Engagement of community
•Practice model
•Business model
New Value Proposition Created

25. New Practice Models Need Seven Things
• Systems Integration (> 7)
• Focus on patient/consumer (>6)
• Radical efficiencies in resource use (>4)
• Team based care (>6)
• Collaborative practice (>3)
• Community- Public engagement (>4)
• Integration of behavioral and physical (>5)

26. Why Are We Blind?
• Systems
• Consumer
• Efficient
• Teams
• Collaboration
• Public Health
• Behavioral

27. Abraham’s World and Its Problems

28. To Improve …
• Modern science
• Practice and research
• Autonomy
• State regulation
• Control by the profession
• Standard regulation

29. A Century Passes…
• Knowledge becomes siloed
• Consumer are isolated, ignored and
powerless
• Professions become wholly autonomous
• System and incumbents become
disengaged from general health and well
being
• General wisdom gives way to specialized
information

30. What would Abe see today?
• Shocking cost of care
• Knowledge that moves
• Consumer unrest
• Babel of our enterprise
• Unskilled professionals
• Fatal disconnect professionals and the
public

31. Nursing and the Transition
Problem
•
Expensive
Solution
•
Unionized
•Right skills
•
Passive mentality
•Future oriented
•
Lack critical
thinking
•
Looming shortage
or
•Patient focused
•Problem solver
•Institution based

32. Nursing leverages reform
• Quality Improved
• Costs lowered
• Consumers satisfied

33. To See the Glass Half Full, ALL Nurses
Must See Themselves as Leaders.
33

34. Six Ways to Build Leadership
34

35. Build from Core Competencies
– care management
– population - systems
context
– teams
– psycho-social-behavioral
– service orientation
– use of resources
– adaptive and innovative
35

36. Work Across the Continuum of Care and
Lead Where You Stand
Community Transitional Healthy Aging
Care
Wellness
Clinics
School
Clinics
Beginning of
Life
Community
Chronic Care
Palliative
Care

37. Focus on the Future
Stop Eating the Young

38. Perform
In the hospital:
• every nurse an agent of quality
• incentivize innovation,
creativity and change
• make them smile, when they
make them smile
• share the gains

39. Be Different

40. Follow These Leadership ABCs
• Bring coherence
• Lead up
• Assert your leadership through
change
• Build leadership skills everywhere
• Expect leadership from every nurse

41. The Myth of Sisyphus
We tend to think of Sisyphus as a tragic hero, condemned
by the gods to shoulder his rock sweatily up the mountain,
and again up the mountain.
The truth is that Sisyphus is in love with the rock. He
cherishes every roughness and every ounce of it. He talks
to it, sings to it. It has become the mysterious Other. He
even dreams of it as he sleepwalks upward. Life is
unimaginable without it, looming always above him like
a huge gray moon.

42. The Myth of Sisyphus
He doesn’t realize that at any moment is
permitted to step aside, let the rock hurtle to
the bottom, and go home.
Tragedy is the inertial force of the mind.
Stephen Mitchell, Parables and Portraits