The Change Codes
You, Your Job, and the Changing World of Healthcare
The Seven Revolutions of Healthcare: The end of medicine as we know it
The community is your customer
Building healthy cities and healthy communities
Why healthcare systems must build healthy communities - and how to do it.
It's pretty wild out there. We are moving from a psychological "terra firma" - the once apparently firm ground of corporate organizations, clearly-understood communities, families built on shared understandings, and lives that made sense -- to a world that feels far more oceanic, with few landmarks, hidden and conflicting currents, and sudden overwhelming storms. The trend toward instability is long-term and global. It is not likely to get easier any time soon. We can learn to adjust. Or we can go beyond adjusting to change. We can use its power.
The Change Codes are rules of thumb derived from observation of hundreds of healthcare organizations, other corporate structures, communities, and families, and the study of the behavior of chaotic and complex adaptive systems -- rules of thumb aimed not at mere survival in a chaotic world, but at being effective, making a difference, improving your own life and the world around you. The Change Codes are a set of clear, down-to-earth guidelines that help people and organizations not only survive change, but discover new energy and power in it.
In a decade of such profound change, no one can say whether a particular job or institution will survive, or what shape it will take. But in our time together we can put our hands on the tools we need to understand what is heading our way. First we will look at the nature of change itself, at what works and what doesn't. We will explore the "Change Codes," a set of clear, down-to-earth guidelines that help people and organizations not only survive change, but discover new energy and power in it. Then we will apply these to healthcare and to your situation in particular. We will look at the multiple profound forces shaping healthcare in this decade, and begin to ask how such things as capitation, "judgment-free" diagnostic and therapeutic methods, genetic markers, the "information highway," and the healthier communities movement will change the multiple roles people within the industry.
Explore the coming decade of advances in technology, communicating and computing: Virtual surgery, smart cards, implanted body monitors, smart hospital rooms, expert systems, smart pill dispensers, Internet search engines, knowbots, robo-docs, virtual communities, personal health information systems.
What happens when you flood the world of healthcare with:
1) cheap, ubiquitous, high-bandwidth connectivity,
2) cheap, vast, fast machine memory,
3) cheap, highly distributed computing power, and
4) cheap, high-resolution sensors?
We think of technology as alienating. But I believe the nature of the new media will lead us in healthcare to a world that combines high tech with high intimacy and high community.
The way we keep ourselves healthy, and what we do when we are sick, will change drastically over the next decade. The future of healthcare is changing in ways that have less to do with stethoscopes and white coats, and more to do with smart cards and dumb terminals, block parties and sewing circles, big bandwidth and microprobes, genetic markers, info-markets, and chaos theory. It's the next medicine, and it doesn't look like anything we've seen yet.
Healthcare is the frame in which we set many of our most profound personal events -- how we are born and how we give birth, how long we live and how we die, how we care for ourselves and each other. And it's changing beyond recognition. Trends are developing in healthcare around the world, each one of which will have revolutionary force. Together they pose the possibility of a chaotic future -- or of an emergent whole that is healthier, and far saner, than the ways we care for each other now.
Who do you serve? Who is your customer? In the "good old days" of fee-for-service and no-questions-asked medical coverage, this was clear: the doctor and the patient.
In an era of managed care, business coalitions, cost-cutting, and systems integration, the answer is changing rapidly. Your "customer" is often some other part of your health care system, or an insurance company, or a local business coalition, or a government agency. Only by meeting the needs of a variety of customers can we survive and prosper. In the end, the multiple trends of the mid-'90s are pushing us to pay attention to one over-riding customer: the health of the local population.
You know what a healthy community is. Somewhere, you've experienced it -- a community that nurtures its members, that makes us all more than we were. But what makes a community healthy?
What builds health, it turns out, also builds community, safety, wealth, and families. The health of a community grows from how many children people have, in what kind of families, with how much money and education, from a sense of choice, and from friends and family who give life meaning, from clean water and air, and basic medicine, from families who eat well, are well housed, secure from crime, and not deranged by drugs or alcohol.
Building a healthy community requires all the energy the community can muster, from everyone who can make a difference -- but it can be done. There are ways to do it. This powerful idea has taken hold in over a thousand cities and towns around the world. This is how to build a world that works.