Monday, February 06, 2006

To Be Or Not To Be: Master Of Our Domain

Locus of Control in the Healthcare Crisis Storm

The problem with a paradigm shift is that by the time most people realize it is occurring it is already fully embedded itself into society. The Industrial Revolution is a prime example of a paradigm shift that occurred in western civilization that transformed us away from an agrarian society in a relatively short period of time. In the United States the majority of our society went from rural farmers to urban factory workers over the course of one century. From a historical perspective that is a blink of an eye. What if such a grand transformation is occurring today in our Healthcare System? Would we recognize it, and if we did what would be our response? Do we believe we are up to such a task?

Step 1: See the gathering storm in the distance

The first question we may want to consider is, "Is there a paradigm shift even occurring in our Healthcare System?" If you believe, as I do, that there is one occurring, and it is not obvious to the world, then we must seek evidence that such a shift is indeed occurring. If you do not believe one is occurring it is not incumbent upon you to provide proof that one is not occurring. Let's face it, paradigm shifts do not occur very frequently to justify a large number of people spending an undue amount of time chasing after proof of their non-existence. Proof of their emergence is therefore generally sought out by those who suspect one is occurring. There is one caveat for those who believe a change in the weather is not occurring: Don't forget to stow some inclement weather gear just in case.

Step 2: Prepare for a change in plan

If a paradigm shift was not occurring, could one be initiated and therefore radically transform a troubled Healthcare System? The examples of major paradigm shifts and the individuals who contributed to them are numerous (Copernicus, Newton, Einstein). The Industrial and Digital Revolutions were less any one individual and really more a growing series of individuals and groups who contributed to the changes that became essential for those paradigm shifts to occur. If one were to occur it would most likely occur in the fashion of the Industrial and Digital Revolutions. That is, over time and as a result of many contributions culminating in a radically transformed and improved way of delivering healthcare to our society. It can happen even if it is not happening. I just happen to be one of those who believes it is already happening.

Step 3: Design the best plan possible

If a paradigm shift is occurring and you recognize it, can you alter its course or modify its affects? That is, can an individual or a group exert an influence over the paradigm shift and shape its course? If you believe one can initiate a paradigm shift there is a tendency to believe you can change its course. What strikes me as curious in this attempt is that the concept of a paradigm shift has at its core the revealing of a fundamental truth that was not previously known. Paradigm shifts can also utilize available resources in a unique manner so as to transform the prevailing established paradigm. Altering it is best accomplished by understanding it better in order to improve it. To do otherwise is an attempt to bury it or to tarnish it in such a way as to hide it once again from society. I think this is why Thomas Kuhn proposed that a true paradigm shift is always different and better. If you believe you can alter its course, the time and energy you spend is better focused on improving the new paradigm. The substance of the debate is not over if it can be altered so much as what is the nature of the new paradigm and what is the best way to go about enabling and improving it?

Step 4: Act on yourself as well as your environment

The final question I leave for today is, "If a paradigm shift is occurring and you are caught in its wake can you alter or modify your response to it?" This is the essence of locus of control. If it is occurring and you have no control over it or yourself then you place yourself in the hands of fate. It therefore doesn't matter if one is occurring or not because you can't control it. (See advice under Step 1.) If, on the other hand, you feel a greater sense of control in the world, you will want to modify the paradigm shift and your response to it for the better. Proving a paradigm shift is occurring is only important to those who feel they have some control over what is happening in the world around them or at least how they will respond to it. So are you master of your domain?

Step 5: Leave the world a better place than when you arrived

The fundamental objective of a Healthcare system is to improve the health of that system's society. We are in the midst of a Healthcare crisis in the United States. There is a tendency to blame it on greed, incompetence and corruption of the individuals who contribute to our system. What I''m suggesting here is that our current Healthcare system has outgrown itself and is undergoing a transformation into a new system. The crisis happening before our eyes is the affects of an established paradigm of delivering healthcare struggling to sustain itself as a new paradigm for delivering healthcare is emerging . We can choose to see it or not. If we see it, we can choose to work to improve it as it emerges, or not. As we see it emerge and begin to affect us we can choose how we wish to respond to it, or not. If you believe you have a choice, those choices ultimately begin with seeing the transformation in the first place. We must start seeing the better system we need.

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