A difficult battle for me as a young health care change agent is the daily battle against succumbing to the traditional thinking of health care. I, along with many students I know, whole-heartedly leapt into this field primarily for altruistic reasons.
Be that as it may…
Tradition is a difficult opponent. The way we have done things for years in health care is a path-dependent monstrosity fronting as a merciless beast. The ramifications of misplaced, misalligned incentives drive daily decision making in health care. The axiom “no margin, no mission” is very real.
But the beast must be defeated. Sure, a paradigm shift is possible—people can change. Another approach has health care organizations hiring leaders from outside the industry. I may be biased, but how about another approach: hiring relatively unseasoned individuals into leadership positions for fresh perspective and new insight to mix with the wily veterans of health care management? Individuals who may not show the wear and tear (and thus unaware of the “way things used to be”) of the incessant health care bureaucracy.
I turn to America’s pastime, baseball.
The Texas Rangers hired Jon Daniels as their GM in 2005 at the ripe age of 28 to replace embattled baseball veteran John Hart. While Mr. Daniels has yet to achieve the success of Mr. Epstein, the risky move by the Rangers could provide some transferable insight to health care.
From Fast Company:
He inherited from Hart one of the game’s biggest messes — an overpriced roster and a weak farm system. To clean that up, he transformed the front office, where the mess was made. “I like to think of myself as a collaborative decision maker, not a power-hungry boss,” he says. “I want everyone’s opinion.” By everyone, he means the members of one of MLB’s quirkiest front-office staffs — about 50% wizened baseball vets like Welke and Hart, and 50% pups like Preller, now Texas’s scouting director, and assistant GM Thad Levine, 36. “I’m obviously in charge,” Daniels says, “but a good leader knows his limitations and doesn’t try to hide them. He trusts the people around him.”
Daniels’s team building has extended, necessarily, to the Rangers’ player development. Before his arrival, Texas had one of baseball’s most barren minor-league systems and most overpaid Major League clubhouses. (Who can forget how the team, in 2000, signed free agent Alex Rodriguez to an unheard-of 10-year, $252 million contract, then finished last in the AL West in the subsequent three seasons?) Last summer, after first baseman Mark Teixeira rejected an eight-year, $140 million offer, Daniels traded him to Atlanta for five prospects. Though the Rangers signed a handful of veterans leading into the ’08 season, none was especially high-priced and none got more than a two-year deal. “We want to stockpile our system with youth,” Daniels says, “to the point where we no longer have to sign a free agent.”
While the Rangers await the fruits (wins) of the decision to hire Daniels, the strategy has transformed the organization into a forward-thinking, build from within, baseball club. A strategy smaller market teams have been using for years (with success, think the A’s, Marlins, Twins). And a strategy baseball’s traditionally competitive large market franchises like the Yankees and Red Sox have begun to employ.
The decisions to hire young, highly talented, individuals has paid off for the Red Sox in two World Series titles and for the Rangers in a revamped, re-energized, poised-for-future-success ball club. Satisfying results for the present, yet transforming the role of the baseball general manager.
Health care needs a similar shot in the arm. Not necessarily at the top. But most definitely in some of the roles that report to the top. Not being battle hardened can be a good thing, especially when it brings new and innovative thinking to health care’s front offices. Thinking not biased toward past (current) paradigms.
The beast is the enemy. It just might be worth a shot.