Friday, February 10, 2006

Collapse & Our Healthcare System

The Three Main Reasons: Values, Values and Values

There is a quote in Jared Diamond's latest book, "Collapse: How Societies Choose to Fail or Succeed", that I think summarizes what I see happening in our Healthcare System today.

"That proves to be a common theme throughout history and also in the modern world...: the values to which people cling most stubbornly under inappropriate conditions are those values that were previously the source of their greatest triumphs over adversity." (p. 275)

The values of the established paradigm for delivering healthcare are conflicting with the values of an emerging paradigm for delivering healthcare. It is our insistence on maintaining those established values which is the source of some of our greatest conflicts in our Healthcare System.

Values vs. Values

Several years ago I repeated an exercise that I originally did almost fifteen years ago. This is how the exercise works. Take out a piece of paper and write down as many values as you believe are near and dear to your heart and soul. From that list choose twenty that you claim as your top twenty values. Take your time because this is really an important exercise. Let's call this final list of twenty your most cherished core set of values. Now take that list and rank them in terms of their importance to you. How I did it was to create a matrix with the value list written down one side of the paper and an identical value list across the top of the paper. Value by value compare them and make a notation on the matrix as to which value ranks higher. For instance compare health vs. security or love vs. success. When you have completed the list put it away for a period of time. In my case it turned out to be twelve years. It wasn't by intention, life just passed by very quickly during those twelve years. At the end of the time period pull out the original unranked list and repeat the same exercise. When I did it the results absolutely amazed me.

The Changing Value of Values

Remember to use the same list as the original, that is (was) your most cherished core values list. I figured some of the values might move around one or two places on the rank order of importance but I had no idea that some of my core values would move so far up and down. I initially created the rank list just after I completed medical school. It was a thrilling and anxiety laden time. The competition to do well in medical school was intense. Honors grades are sought out to insure matching in a better residency program. In the final two years these grades are primarily determined on how you perform on your clinical rotations. The approval of your senior residents and attendings is paramount. Looking at my value list from those days it was not too surprising that "approval" was on it. I'm still amazed how high I ranked it at the time. Twelve years later it dropped to the bottom of the list and in all likelihood would have fallen off had I not used the same list. In retrospect, "approval" probably was very important then, but my life is much different now. As I age I also noticed that "health" moved up on the list from its previous position. Integrity, honesty, freedom and trust remain near the top as they did for the original rank list. There are some values which are more resistant to change then others.

"I changed the most by not changing at all."
Eddie Vedder of Pearl Jam

Since that time I've gone on to further develop the list and discovered something interesting. I do have a core set of values that remains at or near the top of the list which are fairly constant and enduring. There is also a set of values that can change over time as my life circumstances change. They remain valued but their relative importance adjusts based on where I am at in my life. It is not that I didn't value "health" at a younger age. I did, that is how it got on the original list. It is just as I get older I value it even more and therefore relative to other values it rises on the list. As it rises on the list it guides the choices I make in life. (That is another way of saying those days of partying until the sun comes up are long since gone.) If you have any doubt about the relative value of values think about one of our major current political debates. Civil liberties versus homeland security. The 9/11 terrorist strike became one of those life circumstances that framed the nature of how we debate that issue today. Before 9/11 it would have been a different discussion.

Adapting to Our Future

So what does this have to do with our current Healthcare crisis? Everything, I think. It seems there is a constant stream of debate on this issue. Some have gone so far as to say our Healthcare System is going to collapse in the near future. I doubt this, but do believe that our currently established model for delivering healthcare is being transformed into a new model. The established paradigm is making way for an emerging new paradigm. What we are experiencing as a crisis is the heat and sparks caused by the friction of values passing each other on our national ranking list. It is not that we don't value those values that supported the established paradigm for delivering healthcare as it has done successfully for years, it is that we are coming to believe other values need to be more valued to support the new paradigm for delivering healthcare.

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