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I felt honored to be asked to speak on mission-, vision-, and values-based business planning to approximately 100 physicians and allied healthcare professionals earlier this month. I summarized an article I had written in response to a chief operating officer who dismissed a practicing physician with an idea of how to shorten the time from presentation to diagnosis for patients with a prostate mass.
"Fine, now write me a business plan," the COO told the physician.
The physician did just that. Moreover, the business plan I helped him write became the blueprint for a multidisciplinary cancer center (Cohn KH, Schwartz RW. "Business plan writing for physicians." Am J Surg 2002;184(2):114-120).
With that in mind, I gave the audience of physicians and healthcare professionals four principal reasons to write a business plan:
Autumn in New England seems like a fitting metaphor for healthcare reform, in that it requires us to let go of the past and prepare for an uncertain future.
Recently, I spoke to the Physician CEO Healthcare Roundtable on "Healthcare: What's Next." To deal with my uncertainty, I used Prof. Michael Porter's Framework1, which states that healthcare organizations must meet seven different conditions to move from a volume-based to a more value-based healthcare system.
"We face a serious dilemma," recounted a community hospital CEO who participated in my seminar, Practical Strategies for Engaging Physicians. "If we stop doing fee for service now, it will cost us millions of dollars. On the other hand, if we wait, the trap door may close behind us. We need to be ready to flip the switch."
All the other CEOs in the room nodded their heads.
The fundamental challenge in the transformation of U.S. healthcare from volume to more value-based metrics is readiness in an uncertain environment. As I've noted, "complex adaptive systems involve a collection of people acting interdependently, such that one group's response changes the context for everyone else."1
by Jeffrey Cohn
Many of us probably recall from high school the exhortation from our math/science teacher to "show your work" on test problems. I remember being irritated about that, thinking if I could come up with the correct answer what was the necessity for showing how I got there.
Looking back I believe that this was in my best interest. In the linear world of high school math and science, there truly is a best way to get to the correct answer, and showing the work allowed the teacher to determine whether I'd learned that pathway accurately.
Moving into college, I'm reminded of my first Introduction to Philosophy exam. When I told my roommate I only filled up 2/3 of a blue book he said I'd get no better than a C+. And he was right.
I was again disappointed, but my professor considered my thinking process just as important as my conclusion. He was trying to help me think in a more expansive way than I was used to. The challenge for me was converting my rapid, tangential, non-linear thinking process into writing.
Showing my work felt redundant--if I actually did think broadly, the way my professor was training me to think, why did I have to convert that to words? The solace was that my roommate's words were a valid interpretation of the professor's perspective: It takes a lot of writing to document an expansive thinking process on a complex topic.
I confess to having an out-of-body experience last week.
As I listened to two orthopedic surgeons state why they could not trust hospital administrators to keep their word, I imagined Ronald Reagan telling a favorite story about twin boys whose parents brought them to a psychiatrist because they seemed to develop extreme personalities.
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