by Dr. Kenneth H. Cohn

I believe that there are no coincidences in my life. As a guest blogger who took the summer "off" to move to the north shore of MA and write my third book (Getting It Done: Lifelines from the Field), I struggled with getting back into posting something each month that will add value.

Feeling the pressure of too many tasks and too little time, I reluctantly acknowledged the call to worship last weekend and found meaning in Rabbi Jack Riemer's responsive reading, "Turning," in which he noted that for leaves, birds and animals, turning comes instinctively--whether it's leaves turning colors, birds heading south or animals storing food for the winter. Yet change for us does not come so easy. Not only does it mean breaking with old habits and perhaps losing face, "it means starting over again."

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In my last post, I wrote that the Patient Protection and Affordable Care Act Section 3022 requires Health and Human Services Secretary Kathleen Sebelius to establish a Shared Savings Program by January 1, 2012, in which authorized providers contract with the secretary to manage and coordinate care for Medicare beneficiaries for three years.

Fifteen months is a short time to put together an accountable care organization (ACO) that meets the approval of HHS, as well as the standards of existing antitrust and anti-kickback regulations. As I mention in my ACHE seminar, the type of model is less important than the process a healthcare organization uses to select the model.

A mentor once confided, "Change feels like failure, when we are in the middle of it." When we are feeling as though we are in the middle of disruptive change, it is easy to act like deer trapped in the headlights of life. Here are a few reasons that I have heard to sit tight:

* "Healthcare reform legislation will be overturned after the November elections."
* "We don't have the manpower to see any more patients."
* "Patients and families want everything possible to be done for them, but don't want to pay for it."

In challenging times like these, I turn to ideas from L.J. Marcus and B.C. Dorn, that remind me why I became a physician and why clinical practice remains an important part of my life: When our patients face a frightening procedure or a discouraging diagnosis, we comfort them by offering a course of action to give them a sense of hope, and with it, a future. This formula is what good medicine is about, and it is time we do the same for ourselves and for our profession.

"Change in and of itself can be exciting as we envision something new and being a part of making it happen," Marcus and Dorn write.

Rabbi Riemer warns that making major changes is not easy. "But unless we turn, we will be trapped forever in yesterday’s ways," he writes.

What do you think? What steps can you take today to turn toward a life of proactive purpose? How can we turn together to improve care for our communities?

I welcome your input.

Ken is a practicing general surgeon/ MBA and CEO of HealthcareCollaboration.com, who works with organizations that want to engage physicians to improve clinical and financial performance.