The exhibit hall was abuzz with looping videos, spinning wheels, scripted sales pitches, candy wrappers unwrapping. Most people walk directly down the middle of the aisle avoiding all eye contact with the medical record and software carnival barkers – just hoping to make it to the coffee station unmolested. It’s sort of the like having to listen to a 2-hour timeshare sales pitch just to get a $50 Outback Steakhouse gift card. And there we sat, Dennis Freeman and I in our humble exhibit booth carnival barking about integrated care. Of course we think of it more as spreading the gospel, but tomAto-tomAHto.
Then she appeared.
I have no idea where she came from, but in the literal blink of an eye she was right in front of me, hand extended for an introductory shake while the other was unloading her large bag onto the cocktail table at which we perched. Before I could even finish my own introduction the questions started. While auctioneering the first 3-4 questions out in under 40 seconds, she was pulling a notepad out of her bag and opened it up to a list of questions that could have only been rivaled by the queries asked by the signers of the Declaration of Independence. Of course there was no time to offer any sort of answer to a question before the next burst out like lead from a Tommy gun, so I just politely nodded and pretended to absorb them while in reality they ricocheted around the booth like super balls. Finally when her lungs could stand it no longer, she relinquished the floor. I turned to Dennis to see if he caught any of it, but he was long gone. The five minute 78-speed stream of buckshot was like pepper spray to him and seconds into it he went to find relief at the coffee urn.
She was excited. She heard Dr. Freeman’s presentation earlier in the day on Cherokee Health Systems’ journey to integrated care, and she was inspired. Her own organization had recently crested the hill of precontemplation to seriously thinking about transforming its own practice, and she wanted the goods. All of them. Right now. Dennis peeked around the side of the booth and saw the lady, exhausted and spent, elbows on the table fixated on me and ready to listen, so he returned.
We actually ended up having a very pleasant conversation. Of course we could not answer many of her questions without learning more about her organization and gaining better perspective, but I think we were able to harness her excitement and sense of overwhelmedness into a more productive, actionable plan. Many of her questions were about things that would occur in much later steps; things that we could not answer without providing proper context – like describing a brief behavioral intervention in primary care for a diabetic patient. Recall, her organization was only now thinking about integrating primary and behavioral health. Trying to describe the level of detail of a skilled behaviorist in a transformed practice environment that has built new patient flow models, aligned specific screening procedures with real-time medical record submission, re-engineered the team-based workforce, and aggressively advocated for a payment methodology to support it, was impractical.
Instead I focused on her own ability – and her organization’s ability – to re-calibrate. In reality we spend about 20-percent of our lives knowing what the hell we’re doing, and the other 80-percent just trying to figure it out. We talked about what that has looked like at Cherokee Health Systems where we certainly undertake comprehensive strategic planning and use advanced metrics and analytics to make the best decisions we can, but also rely on the ole’ “Ready-Fire-Aim” approach as well. Long ago Dr. Freeman established a vision, created the culture to achieve that vision, hired the right people to implement it, and in the meantime was already into implementation. There was no waiting until the time was right, or for when payers caught up with the practice, or for when we hired the perfect candidate. We just did it. And then re-calibrated with what we learned. Know better, do better. I shared that organizations often saddle themselves with deadlines and timeframes by which something of which they know precious little about is to be achieved. It creates overwhelming pressure, which begets irrational decisions and missed opportunities. Take a deep breath. Relax. Trust in your ability to absorb and learn, to adjust and re-calibrate. Create in your organization a culture that doesn’t punish failures and missteps, but rather dissects them and learns from them. Know better, do better.
Just this morning I had one of those rare magical moments with my teenage daughter as we drove to school. We talked about how we sometimes have to make huge decisions in our lives. I told her that right before her older brother was born – and again right before her birth – that I had this overwhelming sense of doom and calamity. I felt like the universe was playing a cruel joke on this baby in that I was going to be its parent. I didn’t know the first thing about being a dad. Even when No. 2 came along, I still felt like I somehow skated by on the first one. She said “yeah, but you figured it out.” I wasn’t really sure about that until that very moment when she validated it to me. Her, and her opinion and perspective on that is the ONLY one that matters.
So just do it. Today at your fingertips you have more information and resources than anyone had even yesterday. Use it, but don’t wallow in it. Just do it.