by Anthony Cirillo

I love to stir the pot and my last post on why patient and person-centered care is not working did just that. I should first qualify my contention from that blog. True, person- and patient-centered care is working in some instances, but honestly, it is taking hold in just a fraction of the health care universe. I may have implied that it is not working at all, and that was not the intent.

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Readers came back to a few issues--trust and leadership. A couple of recent Harvard articles might hold the answer to the leadership question. The first article ("Are You Ready to Manage in an Irrational World?") is a kind of primer for the second.

I particularly like this quote: "Instead of a management philosophy centered around the manager as the play-caller, assigning tasks and motivating people to carry them out, we are told by the neuroscientists that the new management job is one of facilitating more of a customized, do-it-yourself process centered around each newly-energized employee, one centered on questions [often leading] rather than direction."

In the command-and-control, checklist, regulated environment, it's hard to imagine--let alone convince leadership--that adopting this stance will actually help you work your way down the checklist sooner. Yet when you help create context and then empower people to come up with their own solutions, creativity is heightened, new ways emerge and there is a passion around it, because those who helped craft the solutions do so because they authentically want things to change.

The second article, "Leadership in a (Permanent) Crisis", takes the stance that as the economy recovers, things won't return to normal and a different mode of leadership will be required. That leadership will embrace staff empowerment, collaboration and shared problem-solving. Interestingly, they use a Harvard Medical School affiliate as an example of great leadership.

As a blog reader, many of you are or should be aware of Beth Israel Deaconess CEO Paul Levy's blog, Running a Hospital. The transparency and truthfulness of that blog has pulled the medical center out of some precarious situations. That same style has led to the turnaround of the hospital, as well as the article details. What Levy did was simply lay it on the line to his management that things were dire and layoffs were imminent unless they could find creative ways to save those jobs, including asking for sacrifices by the management team. He created the context and his employees transcended any solutions that he alone or his top lieutenants could ever devise.

Fundamental shifts come from self-driven authentic change, driven by people empowered to do so. I think we have created the illusion of some of this in the patient-centered care arena through scripts, training around how to deliver red carpet service, etc. But all of these miss the more systemic issue; people change because they want to change. Leadership has to create that context.

Are healthcare leaders up to this challenge? Are healthcare management programs looking at these new methods? And is the current crop of enlightened leaders in healthcare prepared to mentor and teach others?

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in management and strategic marketing. His article entitled "The Chief Experience Officer" became the basis upon which the Cleveland Clinic started an office of patient experience and hired the first-ever hospital chief experience officer in the country. Contact Anthony at Cirillo@4wardfast.com or at www.4wardfast.com.</em>